Transitional Care: A Priority for Health Care Organizational Ethics
Transitional Care: A Priority for Health Care Organizational Ethics
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DOI：
10.1002/hast.631
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发表时间：
2016-09-01
影响因子：
3.3
通讯作者：
Berlinger, Nancy
中科院分区：
文献类型：
--
作者：
Naylor, Mary;Berlinger, Nancy
大量研究表明，慢性病老年人的医疗保健转型往往管理不善，往往会造成毁灭性的人类和经济后果。管理不善的转变及其后果也发生在年轻、相对健康的人身上，他们拥有足够的资源并准备为自己辩护。尽管有丰富的研究基础证实，基于证据的过渡护理可以增强患者的体验，改善健康和生活质量，并降低成本，但直到最近，组织、监管、财务和文化障碍仍然阻碍了这些经过验证的方法的广泛采用。 《平价医疗法案》的规定，例如减少对三十天再住院率非常高的医院的医疗保险付款，减少了障碍，但在示范项目之外，基于证据的过渡性护理的采用仍然是零星的，而且速度太慢。随着对如何更好地预测和应对患者、家庭护理人员和医疗保健专业人员在急性疾病期间所经历的紧迫问题的深入了解，现在是将过渡性护理视为老龄化社会中一个系统的道德责任的时候了。将过渡性护理纳入医疗保健系统的道德义务中需要护士和护理人员的观点和参与，因为该职业在护理过渡的各个方面都发挥着不可或缺的作用。
Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence‐based transitional care enhances patients’ experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and cultural barriers have, until recently, prevented widespread adoption of these proven approaches. Provisions of the Affordable Care Act, such as reductions in Medicare payments to hospitals with very high thirty‐day rehospitalization rates, have reduced barriers, but uptake of evidence‐based transitional care beyond demonstration projects continues to be sporadic and far too slow. With a rich understanding about how to better anticipate and respond to the compelling problems experienced by patients, family caregivers, and health care professionals throughout episodes of acute illness, the time has come to frame transitional care as a system's ethical responsibility in an aging society. Embedding transitional care within the ethical obligations of a health care system requires the perspectives and involvement of nurses and nursing because of this profession's integral role in every aspect of care transitions.