Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056, Basel, Switzerland.
Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital Bern, CH-3010, Freiburgstrasse, Bern, Switzerland.
BMC Health Serv Res. 2024 Mar 22;24(1):367. doi: 10.1186/s12913-024-10751-4.
Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study's central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare.
This analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses-with the latter adjusting for dependencies within agencies-to explore which key factors are associated with coordination.
The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism ("communication and information exchange" (beta = 0.10, p <.001)) and four implicit coordination mechanisms-"knowledge of the health system" (beta = -0.07, p <.01), "role clarity" (beta = 0.07, p <.001), "mutual respect and trust" (beta = 0.07, p <.001), and "accountability, predictability, common perspective" (beta = 0.19, p <.001)-were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes.
Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.
家庭护理客户服务通常分布在几个相互依存的医疗保健提供者之间，因此适当的护理协调至关重要。然而，由于探索家庭护理环境中的护理协调的研究很少，因此在各种因素如何影响该护理领域的协调方面存在严重的知识差距。为了填补这些空白，本研究的核心目标是探讨外部因素（即财务和监管机制）和家庭护理机构特征（即工作环境、劳动力和客户特征）与家庭护理中的护理协调之间的关系。
这项分析是瑞士家庭护理环境中的一项全国性多中心、横断面研究的一部分，该研究包括对瑞士 88 家家庭护理机构进行分层随机抽样。数据于 2021 年 1 月至 9 月通过机构和员工问卷收集。我们使用新开发的 COORA 护理协调框架对我们的变量进行建模，以评估结构、过程和结果层面的护理协调相关组成部分。我们进行了描述性和多层次回归分析-后者对机构内的依存关系进行了调整-以探讨哪些关键因素与协调相关。
最终样本量由 71 家家庭护理机构的 1450 名员工组成。我们发现，一种明确的协调机制（“沟通和信息交流”（β=0.10，p<.001））和四种隐含的协调机制-“对卫生系统的了解”（β=-0.07，p<.01）、“角色明确”（β=0.07，p<.001）、“相互尊重和信任”（β=0.07，p<.001）和“问责制、可预测性、共同观点”（β=0.19，p<.001）-与员工感知的协调显著正相关。我们还发现，机构特征和外部因素的影响是通过协调过程介导的。
隐含的协调机制可以促进和增强团队沟通，需要进一步研究。在制定加强隐含机制的策略时，需要整个护理团队的参与，以创建能够促进沟通和信息交流的结构（即明确机制）。适当的协调过程似乎可以减轻人员配备与协调之间的关联。这表明，即使工作量和加班时间较高，它们也支持协调。
