Redesigning acute care for cognitively impaired older adults: Optimizing health care services
Redesigning acute care for cognitively impaired older adults: Optimizing health care services
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DOI：
10.1177/1471301214547089
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发表时间：
2016-09-01
影响因子：
2.4
通讯作者：
Chodosh, Joshua
中科院分区：
文献类型：
--
作者：
LaMantia, Michael A.;Boustani, Malaz A.;Chodosh, Joshua
研究目的：认知障碍（Cl）是已知影响老年人住院、住院时间和再住院的几个因素之一。重新设计对氯离子影响敏感的护理提供系统可以减少急性护理的利用，同时提高护理质量。为了建立医疗保健重新设计的基本需求基础，我们与住院和门诊服务提供者进行了焦点小组讨论，以确定障碍、促进因素和改进Cl患者护理服务的建议。设计和方法：与提供者进行焦点小组会议，以确定他们照顾认知障碍住院成人的方法；提供这种护理的障碍和促进因素；以及改善护理过程的建议。使用主题分析，两名评论者分析这些文本以开发代码和主题。结果：焦点小组记录中出现了七个主题。主要有：(1)对服务认知障碍人群的思考；(2)感知到的护理障碍的描述；(3)改善或促进住院老年人护理的策略；(4)建立一个适合老年人需要的医院的重要性；(5)对医护人员、患者和护理人员进行教育的必要性；(6)良好沟通的中心作用；(7)提供更有效护理所需的步骤。启示：为老年Cl患者提供有效的急性护理服务是医疗改革的重要挑战。从多个专业学科的角度出发的理解是重要的第一步。未来的研究将建立在这一初步研究的基础上，以开发新的Cl患者急性护理模式。
Purpose of the study: Cognitive impairment (Cl) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of Cl may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with Cl.Design and methods: Focus group sessions were conducted with providers to identify their approach to caring for cognitively impaired hospitalized adults; obstacles and facilitators to providing this care; and suggestions for improving the care process. Using a thematic analysis, two reviewers analyzed these transcripts to develop codes and themes.Results: Seven themes emerged from the focus group transcripts. These were: (1) reflections on serving the cognitively impaired population; (2) descriptions of perceived barriers to care; (3) strategies that improve or facilitate caring for hospitalized older adults; (4) the importance of fostering a hospital friendly to the needs of older adults; (5) the need for educating staff, patients, and caregivers; (6) the central role of good communication; and (7) steps needed to provide more effective care.Implications: Providing effective acute care services to older adults with Cl is an important challenge in health care reform. An understanding derived from the perspective of multiple professional disciplines is an important first step. Future research will build on this preliminary study in developing new acute care models for patients with Cl.