Determining Community Provider Practices in Hospices: The Challenges of Documentation.
Determining Community Provider Practices in Hospices: The Challenges of Documentation.
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DOI：
10.1097/njh.0b013e3181bd03cd
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发表时间：
2009-11-01
期刊：
影响因子：
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通讯作者：
McNichol P
中科院分区：
文献类型：
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作者：
Bergen-Jackson K;Sanders S;Herr K;Fine PG;Titler M;Forcucci C;Reyes J;McNichol P
记录是支持临终关怀机构中患者护理的一致性和质量的关键因素，然而，在我们的国家癌症研究所 (NCI) 资助的研究“老年人癌症疼痛：促进临终关怀中的循证实践 (EBP)”的初始数据收集阶段，观察到项目提供者的实践（包括记录）存在差异。该研究是一项随机试验，旨在测试多方面的干预措施，以促进采用和维持 EBP 来治疗癌症疼痛，涉及 16 个中西部不同规模和结构的临终关怀医院。面对这种差异，特别是在缺乏统一采用的结果衡量标准和记录标准的情况下，这个重要且不断发展的医疗保健行业的质量改进举措将难以管理。本文提供了关于临终关怀环境中记录的重要性、质量措施、护理结果和监管要求的背景，以及我们研究中的具体观察结果和对记录实践变化的建议。根据我们的观察，我们认为有必要在临终关怀中采用标准化文件流程支持的相关结果衡量标准。文件系统中关键实践指标和患者结果测量的统一将推动提高临终关怀护理质量和一致性的运动。文件系统和语言的标准化也将促进临终关怀环境中研究的进行，对于临终关怀人群来说，先进的知识对于确保临终时的高质量护理至关重要。
Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our research study and suggestions for changes in documentation practices. From our observations, we posit the necessity of pertinent outcome measures supported by standardized documentation processes in hospice. Uniformity in key practice indicators and patient outcome measures in documentation systems would advance the movement to improve quality and consistency of care in hospices. Standardization of documentation systems and language would also facilitate the conduct of research in the hospice setting, a population for which advancing knowledge is essential to assure quality care at the end of life.