A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals.
A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals.
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DOI：
10.1186/s12913-018-3246-z
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发表时间：
2018-06-20
影响因子：
2.8
通讯作者：
Gammon D
中科院分区：
文献类型：
--
作者：
Berntsen G;Høyem A;Lettrem I;Ruland C;Rumpsfeld M;Gammon D
以人为中心的综合护理(PC-IC)被认为可以改善患有多种长期和复杂疾病的患者的预后和体验。对于如何获得患者体验的PC-IC质量，还没有广泛的共识。大多数PC-IC评估工具侧重于护理事件或一般护理。在前人和我们前人工作的基础上，我们概述了一个面向目标的4阶段PC-IC过程理想：1)个性化目标设置2)与目标相一致的护理计划3)按计划提供护理，4)目标实现情况的评估。我们的目标是探索、应用、完善和运作这一护理质量框架。本文是根据慢性护理的理想，对19名经策略选择的多发病患者的个体患者路径(IPP)经历的定性评估回顾。IPP包括所有护理活动，按时间组织，解决收集到的健康问题。我们构建了基于电子健康记录(来自全科医生、护理服务和医院)和患者随访访谈的IPP。该框架的应用和完善是并行的过程。这两种方法都是根据PC-IC进程的理想对经验材料中的突出主题进行分析，并逐步更充分地应用主题和问题。被调查者通过护理如何支持/威胁他们的长期目标来始终如一地审查护理质量。个人目标要么是隐含的，要么是通过“什么对你重要？”来确定。告知者期望护理能够解决他们的长期目标，并将护理质量和提供的责任置于系统层面。PC-IC流程框架暴露了系统在确定长期目标、提供共享的长期多发病护理计划、监测护理提供和目标评估方面的失误。PC-IC框架包括对PC-IC过程每个阶段的理想护理、关键问题和文献参考的描述。PC-IC工艺框架的第一个版本需要在其他环境中进一步验证。当通过长期目标驱动的PC-IC流程框架进行评估时，基于事件的护理质量框架看不到的护理差距变得明显。该框架似乎对患有多发病的人有意义。本文的在线版本(10.1186/s12913-0183246-z)包含补充材料，可供授权用户使用。
Person-Centered Integrated Care (PC-IC) is believed to improve outcomes and experience for persons with multiple long-term and complex conditions. No broad consensus exists regarding how to capture the patient-experienced quality of PC-IC. Most PC-IC evaluation tools focus on care events or care in general. Building on others’ and our previous work, we outlined a 4-stage goal-oriented PC-IC process ideal: 1) Personalized goal setting 2) Care planning aligned with goals 3) Care delivery according to plan, and 4) Evaluation of goal attainment. We aimed to explore, apply, refine and operationalize this quality of care framework. This paper is a qualitative evaluative review of the individual Patient Pathways (iPP) experiences of 19 strategically chosen persons with multimorbidity in light of ideals for chronic care. The iPP includes all care events, addressing the persons collected health issues, organized by time. We constructed iPPs based on the electronic health record (from general practice, nursing services, and hospital) with patient follow-up interviews. The application of the framework and its refinement were parallel processes. Both were based on analysis of salient themes in the empirical material in light of the PC-IC process ideal and progressively more informed applications of themes and questions. The informants consistently reviewed care quality by how care supported/ threatened their long-term goals. Personal goals were either implicit or identified by “What matters to you?” Informants expected care to address their long-term goals and placed responsibility for care quality and delivery at the system level. The PC-IC process framework exposed system failure in identifying long-term goals, provision of shared long-term multimorbidity care plans, monitoring of care delivery and goal evaluation. The PC-IC framework includes descriptions of ideal care, key questions and literature references for each stage of the PC-IC process. This first version of a PC-IC process framework needs further validation in other settings. Gaps in care that are invisible with event-based quality of care frameworks become apparent when evaluated by a long-term goal-driven PC-IC process framework. The framework appears meaningful to persons with multimorbidity. The online version of this article (10.1186/s12913-018-3246-z) contains supplementary material, which is available to authorized users.
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影响因子：
--
作者：
Cook, RI;Render, M;Woods, DD
通讯作者：
Woods, DD
影响因子：
2.2
作者：
Bayliss, Elizabeth A.;Edwards, Allison E.;Main, Deborah S.
通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
Sparks, Jacqueline A.
影响因子：
2.1
作者：
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通讯作者：
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