维持急性脑卒中治疗新模式：墨尔本移动脑卒中单元的混合方法过程评估。
Sustaining a New Model of Acute Stroke Care: A Mixed-Method Process Evaluation of the Melbourne Mobile Stroke Unit.
机构信息
Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia.
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
出版信息
Int J Health Policy Manag. 2023;12:7716. doi: 10.34172/ijhpm.2023.7716. Epub 2023 Apr 5.
BACKGROUND
Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care.
METHODS
Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted.
RESULTS
There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β=0.61), not experiencing pressure/tension about working on the MSU (β=0.17) and thinking they did well working within the team model (β=0.17) were significantly associated with wanting to continue working within the MSU model [R=0.76; F(15, 60)=12.76, <.001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity.
CONCLUSION
Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.
背景
国际上，移动卒中单元（MSU）救护车改变了院前急性卒中护理的提供方式。MSU 的临床和成本效益研究正在出现，但对于实现这种创新护理模式的可持续性的重要因素知之甚少。
方法
来自墨尔本 MSU（自 2017 年 11 月开始运营）的混合方法研究的过程评估。参与者的目的抽样包括来自维多利亚救护车（AV）（紧急医疗服务提供商）的临床、运营和行政/管理代表、MSU 临床团队和接收医院。可持续性被定义为持续的 MSU 运营，包括 MSU 劳动力和未来的模型考虑。基于理论的在线调查采用统一接受和使用技术理论（UTAUT）、自我决定理论（SDT，内在动机）和针对障碍和益处的开放式文本问题（2019 年 6 月至 9 月）。进行了个别/小组访谈，以征求对持续使用的改进建议和要求。进行了描述性和回归分析（定量数据）以及定向内容和主题分析（开放式文本和访谈数据）。
结果
完成了 135 项调查。确定 MSU 对日常工作有益（β=0.61）、在 MSU 工作时没有感到压力/紧张（β=0.17）和认为自己在团队模型中工作出色（β=0.17）与希望继续在 MSU 模型中工作有显著相关性[R=0.76；F(15,60)=12.76，<.001]。在 MSU 团队成员和与 MSU 合作的人员之间，体验有所不同。为患者（更好、更快的护理）和临床医生（跨学科学习）带来了优势。缺点包括整合到现有系统中的挑战以及建立工作关系。从 35 次访谈中确定的主题是 MSU 团队组成、MSU 车辆设计和布局、人员招聘和轮班、组织之间沟通的改进、远程医疗选择、MSU 运营和调度的特殊性。
结论
出现了影响 MSU 卒中护理模式可持续性的重要因素。具有凝聚力的团队方法，具有可识别的优势和参与组织之间的良好沟通，对于临床和运营的可持续性至关重要。
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