Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea.
Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
J Korean Med Sci. 2023 Aug 14;38(32):e246. doi: 10.3346/jkms.2023.38.e246.
In this study, with the aim of improving the quality of transitional care service for discharged patients, the Health Care Quality and Outcomes Indicators of the Organization for Economic Co-operation and Development and National Health Service Outcomes Framework of the UK were applied to derive service items for provision and develop evaluation indicators under categories of effectiveness, safety, and patient-centeredness.
A scoping review was conducted to derive core concepts and evidence materials/data for transitional care service. For the derived items of transitional care service and evaluation indicators, a three-round Delphi study was conducted with experts in the fields of healthcare/medicine/nursing/social welfare.
First, as a result of the scoping review, components of transitional care service (assessment of need by period of transitional care service, multi-professional team, connection to community resources, etc.) and themes for outcome indicators (effectiveness, patient safety, patient-centeredness) were derived. Second, by classifying the items for assessment according to the hospitalization and transition period and conducting a Delphi study to derive service items for transitional care service, during the hospitalization period, presence/absence of a caregiver and need for a caregiver, activities of daily living, and necessity for home-based care services were identified as items of high priority. Regarding patient safety, risk of falls and fractures during hospitalization, and necessity for medication reconciliation were identified as the items of high importance. For the transition period, provision of education regarding adequate responses and handling of emergencies, provision of information and guidance on application of services for basic livelihood security program beneficiaries, and education for patient skills in self-management of health were derived as items of high priority. Third, for the derivation of outcome indicators for transitional care service, in the "effectiveness" category, the experts rated a reduction in the 30-day readmission rate as an item of high importance along with a decrease in emergency department visits, reduction in preventable admissions as indicators of high relevance. In terms of "patient safety," a decrease in drug adverse reactions, and reduction in the incidence of falls and pressure ulcers were identified as indicators of high priority. Finally, for the category of "patient-centeredness," patient experience assessment, level of service satisfaction reported by patients and their caregivers, and reducing burden on caregivers were identified as indicators of high priority.
This study suggest practical implications for the service with high relevance and necessity for transitional period. It also presented outcome indicators of transitional care service to contribute toward an improvement in the quality of care.
本研究旨在提高出院患者过渡期护理服务质量，借鉴经济合作与发展组织（OECD）医疗保健质量和结果指标和英国国民保健服务（NHS）结果框架，推导出服务项目并制定在有效性、安全性和以患者为中心三个类别下的评估指标。
通过系统评价推导出过渡期护理服务的核心概念和证据材料/数据。对于推导出的过渡期护理服务项目和评估指标，我们对医疗/医学/护理/社会福利领域的专家进行了三轮德尔菲法研究。
首先，通过系统评价，推导出过渡期护理服务的组成部分（按过渡期护理服务的时间段进行需求评估、多专业团队、与社区资源的联系等）和结果指标的主题（有效性、患者安全性、以患者为中心）。其次，通过根据住院和过渡期对评估项目进行分类，并进行德尔菲研究推导出过渡期护理服务的项目，在住院期间，确定了有无护理人员和对护理人员的需求、日常生活活动以及是否需要家庭护理服务作为高优先级项目。关于患者安全，住院期间跌倒和骨折的风险以及药物重整的必要性被确定为高重要性项目。对于过渡期，提供关于适当应对和紧急情况处理的教育、提供关于基本生计保障计划受益人服务应用的信息和指导以及患者自我健康管理技能的教育被推定为高优先级项目。第三，为了推导出过渡期护理服务的结果指标，在“有效性”类别中，专家将 30 天再入院率的降低以及急诊就诊次数的减少、可预防入院的减少作为高重要性指标，将门诊就诊次数的减少作为高相关性指标。在“患者安全性”方面，药物不良反应的减少以及跌倒和压疮发生率的降低被确定为高优先级指标。最后，在“以患者为中心”类别中，患者体验评估、患者及其护理人员报告的服务满意度水平以及减轻护理人员负担被确定为高优先级指标。
本研究为过渡期具有高相关性和必要性的服务提供了实际意义，并提出了过渡期护理服务的结果指标，以提高护理质量。
