调查老年人对紧急护理服务的偏好：一项离散选择实验。

Investigating older people's preferences for an urgent care service: a discrete choice experiment.

作者信息

Ratcliffe Julie, Rahja Miia, Laver Kate, Greene Leanne, Whitehead Craig, Crotty Maria, Mpundu-Kaambwa Christine

机构信息

Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.

Flinders Health and Medical Research Institute, Flinders University, Bedford Park, Australia.

出版信息

BMC Geriatr. 2025 Aug 6;25(1):595. doi: 10.1186/s12877-025-06226-8.

DOI:10.1186/s12877-025-06226-8

PMID:40770307

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12326793/

Abstract

BACKGROUND

Emergency and urgent care, where patients perceive the need for immediate access to medical advice or treatment, comprises a large and significant component of health care delivery. Older people are over-represented in Emergency Departments (ED) and over 55% are likely to be hospitalised with extended lengths of stay. To date, little research has been conducted to assess the needs and preferences of older people concerning alternative models of urgent care. The purpose of this study was to identify older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation using discrete choice experiment methods.

METHODS

Attributes and levels for the Discrete Choice Experiment (DCE) were informed by older people and health care professionals with recent ED experience. Attributes included waiting time for ED admission, knowledge and training of medical professionals, the extent to which the older person is treated holistically, how the physical environment is designed to best support older people, and the level of follow-up care received. The DCE was embedded within a larger survey to assess older people’s (aged >65 years) views and preferences for alternative models of emergency and urgent care. Data were analysed using conditional and mixed logit regressions.

RESULTS

Overall, 995 older people consented to participate and fully completed the DCE. Respondents attached the strongest relative importance to an urgent care service with reduced waiting times (within 2 hours of making the triple zero call), followed by medical professionals with specialist training in the care of older people, holistic support and regular communication updates, physical environment to support older people, and a comprehensive discharge summary and follow up. All of these attribute levels were highly statistically significant (<0.001) in influencing preferences for the total sample and by subgroups reflecting key socio-demographic characteristics and emergency care experience.

CONCLUSIONS

This study has identified older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation. The findings will inform policymakers and practitioners in the design and configuratiCon of an optimal urgent care service model from the perspective of older people.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12877-025-06226-8.

摘要

背景

急诊和紧急护理中，患者认为需要立即获得医疗建议或治疗，这是医疗服务的一个庞大且重要的组成部分。老年人在急诊科（ED）中占比过高，超过55%的人可能会住院且住院时间延长。迄今为止，很少有研究评估老年人对替代紧急护理模式的需求和偏好。本研究的目的是使用离散选择实验方法，确定老年人对紧急护理服务关键特征的偏好，以替代前往急诊科就诊。

方法

离散选择实验（DCE）的属性和水平由有近期急诊科经验的老年人和医疗保健专业人员提供信息。属性包括急诊科入院等待时间、医疗专业人员的知识和培训、对老年人进行整体治疗的程度、物理环境如何设计以最佳支持老年人，以及所接受的后续护理水平。DCE嵌入在一项更大的调查中，以评估老年人（年龄>65岁）对替代急诊和紧急护理模式的看法和偏好。使用条件和混合逻辑回归分析数据。

结果

总体而言，995名老年人同意参与并完整完成了DCE。受访者对等待时间缩短（拨打急救电话后2小时内）的紧急护理服务赋予了最强的相对重要性，其次是接受过老年人护理专业培训的医疗专业人员、整体支持和定期沟通更新、支持老年人的物理环境，以及全面的出院总结和随访。所有这些属性水平在影响总体样本以及反映关键社会人口特征和急诊护理经验的亚组的偏好方面均具有高度统计学意义（<0.001）。