“让系统发挥作用”：一项关于营养师使用电子综合病历支持营养不良老年人营养护理过渡的多地点定性研究

'Making the System Work': A Multi-Site Qualitative Study of Dietitians' Use of iEMR to Support Nutrition Care Transitions for Older Adults with Malnutrition.

作者信息

Gomes Kristin, Roberts Shelley, Desbrow Ben, Bell Jack

机构信息

School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia.

Allied Health Research, Gold Coast Hospital and Health Service, 1 Hospital Blvd., Southport, QLD 4219, Australia.

出版信息

Healthcare (Basel). 2025 Sep 5;13(17):2227. doi: 10.3390/healthcare13172227.

DOI:10.3390/healthcare13172227

PMID:40941579

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12428660/

Abstract

BACKGROUND

Older adults with malnutrition (≥65 years) require coordinated nutrition care during hospital-to-home transitions. A key purpose of integrated electronic medical record (iEMR) systems is to support clinicians in ensuring continuity of care across settings, yet little is known about their use in nutrition care discharge practices. This study explored how clinical dietitians use the iEMR to support nutrition care discharge practices for older adults with malnutrition and identified opportunities for optimisation to enhance care continuity.

METHODS

Semi-structured interviews were conducted with 16 clinical dietitians (11 frontline clinicians, 5 senior leaders) from 10 public hospitals across Queensland, Australia. Analysis combined deductive coding using the Consolidated Framework for Implementation Research 2.0 with inductive thematic analysis to identify system-level, organisational and behavioural influences on iEMR use and optimisation opportunities.

RESULTS

Four themes and ten subthemes were identified. System fragmentation, policy constraints and documentation burden limited dietitians' ability to coordinate discharge care. Workarounds were common and reflected both practical adaptation and conditional trust in iEMR. Discharge practices were also shaped by local culture, professional norms and variable expectations for iEMR use. Despite these constraints, participants expressed aspirations for an optimised iEMR with embedded referral tools, real-time alerts and analytics to support improved service delivery.

CONCLUSIONS

This study identified key factors influencing iEMR use by clinical dietitians to support nutrition care transitions for older adults with malnutrition. While current systems present significant challenges, optimising iEMR alongside organisational and policy enablers holds potential to strengthen nutrition care discharge practices and care continuity.

摘要

背景

营养不良的老年人（≥65岁）在从医院过渡到家庭的过程中需要协调的营养护理。集成电子病历（iEMR）系统的一个关键目的是支持临床医生确保不同环境下护理的连续性，但对于其在营养护理出院实践中的应用却知之甚少。本研究探讨了临床营养师如何使用iEMR来支持营养不良老年人的营养护理出院实践，并确定了优化的机会以增强护理的连续性。

方法

对来自澳大利亚昆士兰州10家公立医院的16名临床营养师（11名一线临床医生，5名高级领导）进行了半结构化访谈。分析结合了使用实施研究综合框架2.0的演绎编码和归纳主题分析，以确定对iEMR使用和优化机会的系统层面、组织层面和行为层面的影响。

结果

确定了四个主题和十个子主题。系统碎片化、政策限制和文档负担限制了营养师协调出院护理的能力。变通方法很常见，反映了对iEMR的实际调整和有条件的信任。出院实践也受到当地文化、专业规范和对iEMR使用的不同期望的影响。尽管存在这些限制，参与者仍表达了对优化iEMR的期望，希望其具备嵌入式转诊工具、实时警报和分析功能，以支持改善服务提供。