痴呆症患者护理协调方面的差距。
Gaps in the coordination of care for people living with dementia.
机构信息
Weill Cornell Medicine, New York, New York, USA.
Clinical Directors Network, New York, New York, USA.
出版信息
J Am Geriatr Soc. 2024 Oct;72(10):3119-3128. doi: 10.1111/jgs.19105. Epub 2024 Jul 29.
BACKGROUND
One-third of people living with dementia (PLWD) have highly fragmented care (i.e., care spread across many ambulatory providers without a dominant provider). It is unclear whether PLWD with fragmented care and their caregivers perceive gaps in communication among the providers involved and whether any such gaps are perceived as benign inconveniences or as clinically meaningful, leading to adverse events. We sought to determine the frequency of perceived gaps in communication (coordination) among providers and the frequency of self-reported adverse events attributed to poor coordination.
METHODS
We conducted a cross-sectional study in the context of a Medicare accountable care organization (ACO) in New York in 2022-2023. We included PLWD who were attributed to the ACO, had fragmented care in the past year by claims (reversed Bice-Boxerman Index ≥0.86), and were in a pragmatic clinical trial on care management. We used an existing survey instrument to determine perceptions of care coordination and perceptions of four adverse events (repeat tests, drug-drug interactions, emergency department visits, and hospital admissions). ACO care managers collected data by telephone, using clinical judgment to determine whether each survey respondent was the patient or a caregiver. We used descriptive statistics to summarize results.
RESULTS
Of 167 eligible PLWD, surveys were completed for 97 (58.1%). Of those, 88 (90.7%) reported having >1 ambulatory visit and >1 ambulatory provider and were thus at risk for gaps in care coordination and included in the analysis. Of those, 23 respondents were patients (26.1%) and 64 were caregivers (72.7%), with one respondent's role missing. Overall, 57% of respondents reported a problem (or "gap") in the coordination of care and, separately, 18% reported an adverse event that they attributed to poor care coordination.
CONCLUSION
Gaps in coordination of care for PLWD are reported to be very common and often perceived as hazardous.
背景
三分之一的痴呆症患者（PLWD）存在高度碎片化的护理（即，护理分散在许多门诊提供者之间，没有主导提供者）。目前尚不清楚是否存在碎片化护理的 PLWD 及其护理人员是否认为所涉及的提供者之间存在沟通差距，以及任何此类差距是否被视为良性不便，还是具有临床意义，从而导致不良事件。我们旨在确定感知到的提供者之间沟通（协调）差距的频率，以及归因于协调不善的自我报告不良事件的频率。
方法
我们在 2022-2023 年期间在纽约的一个医疗保险责任制医疗组织（ACO）中进行了一项横断面研究。我们纳入了归因于 ACO 的 PLWD，过去一年中通过索赔（反向 Bice-Boxerman 指数≥0.86）存在碎片化护理，并且正在参加关于护理管理的务实临床试验。我们使用现有的调查工具来确定对护理协调的看法以及对四种不良事件（重复测试、药物相互作用、急诊就诊和住院）的看法。ACO 护理经理通过电话收集数据，使用临床判断来确定每位调查受访者是患者还是护理人员。我们使用描述性统计来总结结果。
结果
在 167 名符合条件的 PLWD 中，完成了 97 项（58.1%）调查。其中，88 名（90.7%）报告有>1 次门诊就诊和>1 次门诊就诊提供者，因此存在护理协调差距的风险，并纳入了分析。其中，23 名受访者是患者（26.1%），64 名是护理人员（72.7%），一名受访者的角色缺失。总体而言，57%的受访者报告护理协调存在问题（或“差距”），另有 18%的受访者报告他们归因于护理协调不善的不良事件。
结论
报告称 PLWD 的护理协调差距非常普遍，并且经常被认为是危险的。
Zotero 插件