Family Perspectives on High-Quality Pediatric Subspecialty Referrals
Family Perspectives on High-Quality Pediatric Subspecialty Referrals
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DOI：
10.1016/j.acap.2016.05.147
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发表时间：
2016-08-01
影响因子：
3.1
通讯作者：
Miller, Elizabeth
中科院分区：
文献类型：
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作者：
Ray, Kristin N.;Ashcraft, Laura Ellen;Miller, Elizabeth
目的：虽然儿童经常被转介给专科医生，但从医生和系统的角度来看，转介过程中存在许多不足之处。然而，人们对如何从以家庭为中心的角度全面衡量或提高转诊系统的质量知之甚少。为了促进以家庭为中心的儿科专科转诊的改善，我们试图从患者及其家属的角度制定一个高质量的、以患者为中心的转诊框架。方法：我们使用家长知情的定性分析，对父母、照顾者和患者进行访谈，以确定患者及其家属所感知的高质量儿科专科转诊的结果、过程和结构。结果：我们询问了21名线人。知情者确定了5个期望的结果，专科转诊：改善功能状态或症状;改善长期结果;提高他们的疾病知识;知情的期望;和减少对孩子的健康状况的焦虑。被调查者认为支持这些结果的过程集中在亚专科转诊的6个关键步骤，包括转诊决定、术前信息传递、预约安排、亚专科访视、访视后信息传递以及持续的护理整合和沟通。卫生保健提供结构确定的线人支持这些过程包括物理基础设施，人力资源和信息技术systems.CONCLUSIONS：我们确定了以家庭为中心的成果，流程和结构的高质量儿科专科转诊。这些领域不仅可以用来改善现有转诊系统的质量衡量，而且还可以为未来的干预措施提供信息，以改善需要专科护理的儿童的以患者为中心的结果。
OBJECTIVE: Although children are frequently referred to sub specialist physicians, many inadequacies in referral processes have been identified from physician and system perspectives. Little is known, however, about how to comprehensively measure or improve the quality of the referral systems from a family-centered perspective. To foster family-centered improvements to pediatric subspecialty referrals, we sought to develop a framework for high-quality, patient-centered referrals from the perspectives of patients and their families.METHODS: We used stakeholder-informed qualitative analysis of parent, caregiver, and patient interviews to identify outcomes, processes, and structures of high-quality pediatric subspecialty referrals as perceived by patients and their family members.RESULTS: We interviewed 21 informants. Informants identified 5 desired outcomes of subspecialty referrals: improved functional status or symptoms; improved long-term outcomes; improved knowledge of their disease; informed expectations; and reduced anxiety about the child's health status. Processes that informants identified as supporting these outcomes centered around 6 key steps in subspecialty referrals, including the referral decision, previsit information transfer, appointment scheduling, subspecialist visit, postvisit information transfer, and ongoing care integration and communication. Health care delivery structures identified by informants as supporting these processes included physical infrastructure, human resources, and information technology systems.CONCLUSIONS: We identified family-centered outcomes, processes, and structures of high-quality pediatric subspecialty referrals. These domains can be used not only to improve measurement of the quality of existing referral systems but also to inform future interventions to improve patient centered outcomes for children in need of specialty care.