医院到家健康过渡质量（H3TQ）指数的开发与验证：一种让患者和家庭健康服务提供者参与评估医院到家护理过渡质量的新方法：一种让患者和家庭健康服务提供者参与评估医院到家护理过渡质量的新方法。
Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality.
作者信息
Arbaje Alicia I, Hsu Yea-Jen, Keita Maningbe, Greyson Sylvan, Wang Jiangxia, Werner Nicole E, Carl Kimberly, Hohl Dawn, Jones Kate, Bowles Kathryn H, Chan Kitty S, Marsteller Jill A, Gurses Ayse P, Leff Bruce
机构信息
Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Arbaje, Keita, and Leff and Ms Greyson); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Drs Arbaje, Hsu, Keita, Marsteller, Gurses, and Leff); Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Wang); Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Arbaje and Gurses); Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison (Dr Werner); Johns Hopkins Home Care Group, Baltimore, Maryland (Ms Carl and Dr Hohl); College of Nursing, University of South Carolina, Columbia (Dr Jones); Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, and Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York (Dr Bowles); MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar Georgetown University Hospital, Washington, District of Columbia (Dr Chan); Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Gurses); and Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland (Dr Leff).
出版信息
Qual Manag Health Care. 2024;33(3):140-148. doi: 10.1097/QMH.0000000000000419. Epub 2024 Jun 26.
BACKGROUND
Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions.
OBJECTIVE
To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks.
METHODS
Development : A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing : Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied : Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists).
RESULTS
The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%).
CONCLUSIONS
The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.
背景
住院后需要专业家庭健康护理（HH）的患者发生不良事件的风险很高。人因工程学（HFE）方法可用于制定措施，以优化从医院到家庭的过渡。
目的
描述医院到家庭健康过渡质量（H3TQ）指数的开发、初步心理测量学验证及其可行性，以识别患者安全风险。
方法
开发：在美国农村和城市地区的5个家庭健康机构进行的多地点、混合方法研究。测试：对老年人从医院到家庭健康护理的过渡进行前瞻性H3TQ实施。研究人群：出院后接受家庭健康护理服务的老年人及其照顾者，以及他们的家庭健康护理提供者（护士和康复治疗师）。
结果
H3TQ是一个包含12项内容的指标，用于统计从医院到家庭健康护理过渡过程中的安全最佳实践，我们通过180多个小时的观察和80多个小时的访谈开发了该指标。在对75次过渡进行测试时，H3TQ显示出使用的可行性、稳定性、结构效度和同时效度。绝大多数（70%）从医院到家庭健康护理的过渡至少存在一个安全问题，家庭健康护理提供者识别出的患者安全威胁比患者/照顾者更多。最常识别出的问题是家庭环境不安全（32%）、用药问题（29%）、信息不完整（27%）以及患者对护理计划缺乏总体了解（27%）。
结论
H3TQ是一种评估从医院到家庭健康护理过渡质量并主动识别过渡问题的新指标。患者、照顾者和家庭健康护理提供者提供了有价值的观点，应将他们纳入安全报告中。研究结果可为设计干预措施提供指导，以在高风险的从医院到家庭健康护理过渡期间优化质量。
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