Pepping Rianne M C, van Aken Maarten O, Vos Rimke C, Numans Mattijs E, van den Berg Johanna M W, Kroon Ingrid, van Nieuwkoop Cees
Department of Public Health & Primary Care/Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands.
Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
Int J Integr Care. 2023 Jun 21;23(2):30. doi: 10.5334/ijic.6991. eCollection 2023 Apr-Jun.
Acute respiratory infections are common in frail, community-dwelling older people and are accompanied by considerable diagnostic and prognostic uncertainties. Inadequately coordinated care is associated with unnecessary hospital referral and admission with potential iatrogenic harm. Therefore, we aimed to co-create a regional integrated care pathway (ICP), including a hospital at home journey.
Tasked with using design thinking methodology, stakeholders from regional healthcare facilities, together with patient representatives, were assigned to different focus groups based on their expertise. The focus of each session was to co-create ideal patient journeys suitable for embedding in the ICP.
Based on these sessions, a regional cross-domain ICP was developed that comprises three patient journeys. The first journey included a hospital at home track, the second a tailored visit, with priority assessment, to regional emergency departments, and the third concerned referral to readily available nursing home 'recovery-beds' under the supervision of an elderly care medicine specialist.
Using design thinking and involving end-users during the whole process, we created an ICP for community-dwelling frail older people with moderate-severe acute respiratory infections. This resulted in three realistic patient journeys, including a hospital at home track, which will be implemented and evaluated in the near future.
急性呼吸道感染在体弱的社区老年人中很常见,且伴有相当大的诊断和预后不确定性。护理协调不足会导致不必要的医院转诊和住院,并可能造成医源性伤害。因此,我们旨在共同创建一条区域综合护理路径(ICP),包括居家住院流程。
制定ICP:负责运用设计思维方法,来自区域医疗机构的利益相关者与患者代表根据其专业知识被分配到不同的焦点小组。每一次会议的重点是共同创建适合纳入ICP的理想患者流程。
基于这些会议,制定了一条区域跨领域ICP,它包括三个患者流程。第一个流程包括居家住院路径,第二个是针对区域急诊科的量身定制的就诊,优先进行评估,第三个是在老年护理医学专家的监督下转诊到随时可用的养老院“康复床位”。
通过运用设计思维并在整个过程中让最终用户参与,我们为患有中重度急性呼吸道感染的社区体弱老年人创建了一条ICP。这产生了三个切实可行的患者流程,包括居家住院路径,将在不久的将来实施和评估。