急诊加护的多利益相关者定性评估：以物理治疗为主导的急诊科出院后老年人居家干预过渡方案
A Multi-Stakeholder Qualitative Evaluation of ED PLUS: A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge.
作者信息
Holmes Alison, FitzGerald Christine, Conneely Mairead, O'Connor Margaret, Robinson Katie, Gallagher Aoife L, Cotter Paul E, Galvin Rose
机构信息
School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
出版信息
Clin Interv Aging. 2025 Feb 13;20:147-159. doi: 10.2147/CIA.S469933. eCollection 2025.
INTRODUCTION
Older adults frequently attend Emergency Departments (EDs) and experience high rates of adverse outcomes, including functional decline, re-presentation, and unplanned hospital admissions. Developing effective interventions to prevent these outcomes is a priority. Healthcare providers (HCPs) are well positioned to create integrated care pathways for older adults discharged from the ED. ED PLUS is a physiotherapy-led, multidisciplinary model that bridges the care transition between the ED and the community. It initiates a Comprehensive Geriatric Assessment (CGA) in the ED and provides multidisciplinary follow-up to the patient for six weeks post-discharge.
PURPOSE
This study aimed to explore the views and experiences of older adults and HCPs involved in the ED PLUS intervention to inform the design of a future definitive trial.
METHODS
A descriptive qualitative design was used. Older adults (n = 9) and HCPs (n = 10) who participated in the intervention arm of the ED PLUS trial were invited to participate in semi-structured interviews exploring their experience and perspective of the ED PLUS intervention. These interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis.
RESULTS
Nine older adults and six HCPs consented to participate. The evaluation highlighted stakeholders' experiences and suggested modifications for optimising ED PLUS. Four themes emerged: ED PLUS bridged the transition between care settings for older adults.Stakeholder collaboration and investment were key enablers of implementation.Organisational, logistical, and personnel issues impeded the intervention's delivery.There is potential for service optimisation and expansion.
CONCLUSION
This evaluation emphasises the important role of physiotherapists and other HCPs in transitional care delivery for older adults. The findings will inform future trials of the ED PLUS model, aiming to improve outcomes for this population.
引言
老年人经常前往急诊科就诊，且不良后果发生率较高，包括功能衰退、再次就诊和意外住院。制定有效的干预措施以预防这些后果是当务之急。医疗保健提供者有能力为从急诊科出院的老年人创建综合护理路径。“急诊科加护模式（ED PLUS）”是一种以物理治疗为主导的多学科模式，它架起了急诊科与社区之间护理过渡的桥梁。该模式在急诊科启动全面老年评估（CGA），并在患者出院后六周内提供多学科随访。
目的
本研究旨在探讨参与“急诊科加护模式（ED PLUS）”干预的老年人和医疗保健提供者的观点和经验，为未来的确定性试验设计提供参考。
方法
采用描述性定性设计。邀请参与“急诊科加护模式（ED PLUS）”试验干预组的老年人（n = 9）和医疗保健提供者（n = 10）参加半结构化访谈，探讨他们对“急诊科加护模式（ED PLUS）”干预的体验和看法。这些访谈进行了录音、转录，并采用反思性主题分析法进行分析。
结果
九名老年人和六名医疗保健提供者同意参与。评估突出了利益相关者的体验，并提出了优化“急诊科加护模式（ED PLUS）”的改进建议。出现了四个主题：“急诊科加护模式（ED PLUS）”架起了老年人护理环境之间的过渡桥梁。利益相关者的合作与投入是实施的关键推动因素。组织、后勤和人员问题阻碍了干预措施的实施。服务优化和扩展具有潜力。
结论
该评估强调了物理治疗师和其他医疗保健提供者在为老年人提供过渡性护理方面的重要作用。研究结果将为“急诊科加护模式（ED PLUS）”的未来试验提供参考，旨在改善该人群的治疗效果。
Zotero 插件