Lodge Margot E, Dhesi Jugdeep, Shipway David J H, Braude Philip, Meilak Catherine, Partridge Judith, Andrew Nadine E, Srikanth Velandai, Ayton Darshini R, Moran Chris
National Centre for Healthy Ageing, Melbourne, Australia.
Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia.
Eur Geriatr Med. 2025 Apr;16(2):435-446. doi: 10.1007/s41999-024-01122-7. Epub 2024 Dec 10.
Hospital surgical services that utilise the approach of the perioperative medicine for older people undergoing surgery (POPS) model of care improve outcomes for older people contemplating and undergoing surgery. Complex models of care like POPS may be difficult to implement without understanding the elements that comprise that model of care. Logic models can be used to aid implementation by visually depicting theoretical relationships between the elements of the model of care. Our objective was to understand the core elements of the POPS model of care at health services other than where it was first developed.
A qualitative case study at three contextually different health services in England with POPS models of care of varying implementation maturity was undertaken. We conducted semi-structured interviews with clinicians and managers involved in POPS (n = 56). The interviews were analysed using inductive and deductive methods.
We developed a logic model with seven domains and themes that described the core elements of the POPS model of care compared and contrasted across the three health services. We found POPS could be adapted to 'fit' the local contexts of our study and still achieve its desired outcomes if it remained true to the principles of comprehensive geriatric assessment and optimisation and was delivered by staff with expert skills and attitudes.
Our logic model provides potentially generalisable information about the core elements of the POPS service in three health services. This information can be used to aid the implementation of the POPS model of care in healthcare settings similar to our study. Further research may be required to test the logic model in other healthcare contexts.
采用围手术期老年医学护理模式（POPS）的医院外科服务可改善考虑接受手术和正在接受手术的老年人的治疗效果。像POPS这样复杂的护理模式，如果不了解构成该护理模式的要素，可能难以实施。逻辑模型可通过直观描绘护理模式要素之间的理论关系来辅助实施。我们的目标是了解在最初开发该模式以外的医疗服务机构中POPS护理模式的核心要素。
在英格兰三个背景不同、POPS护理模式实施成熟度各异的医疗服务机构开展了一项定性案例研究。我们对参与POPS的临床医生和管理人员进行了半结构化访谈（n = 56）。采用归纳法和演绎法对访谈进行分析。
我们构建了一个包含七个领域和主题的逻辑模型，该模型描述了在三个医疗服务机构中进行比较和对比的POPS护理模式的核心要素。我们发现，如果POPS坚持综合老年医学评估与优化原则，并由具备专业技能和态度的工作人员提供服务，那么它可以进行调整以“适应”我们研究的当地环境，并且仍然能够实现预期的效果。
我们的逻辑模型提供了关于三个医疗服务机构中POPS服务核心要素的潜在可推广信息。这些信息可用于在与我们的研究类似的医疗环境中辅助实施POPS护理模式。可能需要进一步的研究来在其他医疗环境中测试该逻辑模型。
