Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
Int J Nurs Stud. 2023 Sep;145:104544. doi: 10.1016/j.ijnurstu.2023.104544. Epub 2023 Jun 5.
As health care complexity increases, skilled care coordination is becoming increasingly necessary. This is especially true in homecare settings, where services tend to be highly interprofessional. Poor coordination can result in services being provided twice, at the wrong time, unnecessarily or not at all. In addition to risking harm to the client, such confusion leads to unnecessary costs. From the patient's perspective, then, professional coordination should help both to remove barriers limiting quality of care and to minimize costs. To date, though, studies examining the relationship between care coordination and care quality have faced multiple challenges, leading to mixed results. And in homecare contexts, where the clients are highly vulnerable and diverse care interfaces make coordination especially challenging, such studies are rare.
Therefore, the aim of this study was to explore the relationship, from the perspectives of clients and of homecare professionals, between coordination and quality of care. For both groups, we hypothesized that better coordination would correlate with higher ratings of quality of care. For the clients, we predicted that higher coordination ratings would lead to lower incidence of unplanned health care use, i.e., emergency department (ED) visits, unscheduled urgent medical visits and hospitalizations.
This study is part of a national multi-center cross-sectional study in the Swiss homecare setting. We recruited 88 homecare agencies and collected data between January and September 2021 through written questionnaires for agencies' managers, employees (n = 3223) and clients (n = 1509). To test our hypotheses, we conducted multilevel analyses.
Employee-perceived care coordination ratings correlated positively with employee-rated quality of care (OR = 2.78, p < .001); client-perceived care coordination problems correlated inversely with client-reported quality of care (β = -0.55, p < .001). Client-perceived coordination problems also correlated positively with hospitalizations (IRR = 1.20, p < .05) and unscheduled urgent medical visits (IRR = 1.18, p < .05), but not significantly with ED visits. No associations were discernible between employee-perceived coordination quality and either health care service use or client quality-of-care ratings.
While results indicate relationships between coordination and diverse aspects of care quality, various coordination gaps (e.g., poor information flow) also became apparent. The measurement of both care coordination and quality of care remains a challenge. Further research should focus on developing and validating a coordination questionnaire that measures care coordination.
随着医疗保健复杂性的增加，熟练的护理协调变得越来越必要。在家庭护理环境中尤其如此，因为服务往往是高度跨专业的。协调不善可能导致服务重复提供，时间不当，不必要或根本不提供。除了对客户造成伤害外，这种混乱还会导致不必要的成本。因此，从患者的角度来看，专业协调应该有助于消除限制护理质量的障碍，并最大限度地降低成本。然而，迄今为止，研究协调与护理质量之间关系的研究面临着多重挑战，导致结果不一致。在家庭护理环境中，客户高度脆弱，护理接口多样化，协调尤其具有挑战性，因此此类研究很少。
因此，本研究旨在从客户和家庭护理专业人员的角度探讨协调与护理质量之间的关系。对于这两个群体，我们假设更好的协调将与更高的护理质量评分相关。对于客户，我们预测更高的协调评分将导致计划性医疗保健使用（即急诊就诊、非计划性紧急医疗就诊和住院）发生率降低。
本研究是瑞士家庭护理环境中全国多中心横断面研究的一部分。我们招募了 88 家家庭护理机构，并于 2021 年 1 月至 9 月期间通过机构经理、员工（n=3223）和客户（n=1509）的书面问卷收集数据。为了检验我们的假设，我们进行了多水平分析。
员工感知的护理协调评分与员工评定的护理质量呈正相关（OR=2.78，p<0.001）；客户感知的护理协调问题与客户报告的护理质量呈负相关（β=-0.55，p<0.001）。客户感知的协调问题与住院治疗（IRR=1.20，p<0.05）和非计划性紧急医疗就诊（IRR=1.18，p<0.05）也呈正相关，但与急诊就诊无显著相关性。员工感知的协调质量与医疗保健服务使用或客户护理质量评分之间没有关联。
尽管结果表明协调与护理质量的各个方面之间存在关系，但也明显存在各种协调差距（例如，信息流不畅）。护理协调和护理质量的测量仍然是一个挑战。进一步的研究应侧重于开发和验证衡量护理协调的协调问卷。
