Development of an Interdisciplinary Team Communication Framework and Quality Metrics for Home-Based Medical Care Practices
Development of an Interdisciplinary Team Communication Framework and Quality Metrics for Home-Based Medical Care Practices
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DOI：
10.1016/j.jamda.2016.03.018
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发表时间：
2016-08-01
影响因子：
7.6
通讯作者：
Ritchie, Christine S.
中科院分区：
文献类型：
--
作者：
Fathi, Roya;Sheehan, Orla C.;Ritchie, Christine S.
背景资料：接受家庭医疗护理（HBMC）（即家庭初级保健和家庭姑息治疗服务）的居家成年人的独特需求理想地由提供协调护理的跨学科护理团队（IDT）提供。来自一系列组织的团队成员的组成和在家中提供护理的独特维度对及时访问和传达患者护理信息提出了具体挑战。这项工作的目标是制定一个概念框架和相应的质量指标（QIs），以评估IDT成员如何为HBMC的做法访问和相互沟通的关键病人信息。方法：一个系统的审查同行-进行了审查和灰色文献，以告知家庭护理协调框架和候选QIs的发展，以评估所有IDT成员最佳访问和使用患者信息。一个技术专家小组（TEP）参加了修改后的德尔菲过程，以评估每个QI的有效性和可行性，并确定哪些将是最适合的测试在field.Results：文献的主题分析揭示了4个过程的主题，HBMC的做法可能会从事高质量的护理协调：使用电子医疗记录，进行跨学科团队会议，共享标准化的患者评估，并通过安全的电子消息进行通信。根据这些主题，开发了9个候选质量指标，以反映这些过程。TEP评估了三个候选QI，认为其在HBMC实践环境中有效且可行。这些指标重点关注IDT会议的使用、标准化患者评估和安全电子消息传递。结论：将复杂的护理协调问题转化为QI将改善为接受HBMC的弱势家庭受限成年人提供的护理。在文献的指导下，我们开发了一个框架，以反映在家庭环境中的最佳护理协调，并确定了3个候选QIs在HBMC实践中进行现场测试。爱思唯尔公司出版代表AMDA -急性后和长期护理医学协会。这是CC BY-NC-ND许可下的开放获取文章。
Background: The unique needs of homebound adults receiving home-based medical care (HBMC) (ie, home-based primary care and home-based palliative care services) are ideally provided by interdisciplinary care teams (IDTs) that provide coordinated care. The composition of team members from an array of organizations and the unique dimension of providing care in the home present specific challenges to timely access and communication of patient care information. The objective of this work was to develop a conceptual framework and corresponding quality indicators (QIs) that assess how IDT members for HBMC practices access and communicate key patient information with each other.Methods: A systematic review of peer-reviewed and gray literature was performed to inform a framework for care coordination in the home and the development of candidate QIs to assess processes by which all IDT members optimally access and use patient information. A technical expert panel (TEP) participated in a modified Delphi process to assess the validity and feasibility of each QI and to identify which would be most suitable for testing in the field.Results: Thematic analysis of literature revealed 4 process themes for how HBMC practices might engage in high-quality care coordination: using electronic medical records, conducting interdisciplinary team meetings, sharing standardized patient assessments, and communicating via secure e-messaging. Based on these themes, 9 candidate QIs were developed to reflect these processes. Three candidate QIs were assessed by the TEP as valid and feasible to measure in an HBMC practice setting. These indicators focused on use of IDT meetings, standardized patient assessments, and secure e-messaging.Conclusion: Translating the complex issue of care coordination into QIs will improve care delivered to vulnerable home-limited adults who receive HBMC. Guided by the literature, we developed a framework to reflect optimal care coordination in the home setting and identified 3 candidate QIs to field-test in HBMC practices. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license.