Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities.
Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities.
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DOI：
10.1136/bmjqs-2017-007442
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发表时间：
2018-10
影响因子：
5.4
通讯作者：
Lindenauer PK
中科院分区：
文献类型：
--
作者：
Leyenaar JK;Rizzo PA;O'Brien ER;Lindenauer PK
与出院一样，入院代表与环境、医疗保健提供者和临床管理变化相关的护理过渡。虽然相当大的努力集中在提高医院到家庭过渡的质量和安全性，但很少关注过渡到医院。在因门诊护理敏感条件住院的儿童中，我们的目的是描述家庭从门诊过渡到住院护理的经历，确定对家庭最重要的入院过程和结果，并确定父母的观点如何在直接入院和通过急诊科入院的儿童之间存在差异。我们进行了半结构化的采访，住院儿童的父母在4个结构不同的医院。我们询问了入院前的医疗服务、如何做出入院决定以及家长对入院流程和结果的偏好。访谈被逐字转录，并使用一般归纳法进行分析。我们进行了48次采访。参与者主要是母亲（74%）; 45%的儿童患有慢性病，52%直接入院。儿童在入院前一周内平均有2次[IQR 1-3]医疗保健接触，44%的儿童在多种环境中寻求护理。医疗保健利用的模式受到以下因素的影响：（i）疾病的严重程度和医疗保健的可及性;（ii）过去的经验;（iii）关于初级保健和艾德作为医院守门人的角色的不同观点。参与者的入院优先事项包括：（i）有效的临床护理;（ii）高效的入院流程;（iii）安全和安保;（iv）及时性;以及（v）以患者和家庭为中心的护理流程。家庭在几个环境中接受入院前护理，并在入院过程中描述了不同程度的护理协调。这项研究可以指导医院入院系统的改进，这是实现卫生系统整合和护理连续性所必需的。
Hospital admission, like hospital discharge, represents a transition-of-care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital. Among children hospitalized with ambulatory care sensitive conditions, we aimed to characterize families’ experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families, and determine how parental perspectives differed between children admitted directly and through emergency departments. We conducted semi-structured interviews with parents of hospitalized children at 4 structurally diverse hospitals. We inquired about pre-admission healthcare encounters, how hospital admission decisions were made, and parents’ preferences regarding hospital admission processes and outcomes. Interviews were transcribed verbatim and analyzed using a general inductive approach. We conducted 48 interviews. Participants were predominantly mothers (74%); 45% had children with chronic illnesses and 52% were admitted directly. Children had a median of 2 [IQR 1-3] healthcare encounters in the week preceding hospital admission, with 44% seeking care in multiple settings. Patterns of healthcare utilization were influenced by (i) disease acuity and healthcare access; (ii) past experiences; and (iii) varied perspectives about primary care and ED roles as hospital gatekeepers. Participants’ hospital admission priorities included: (i) effective clinical care; (ii) efficient admission processes; (iii) safety and security; (iv) timeliness; and (v) patient- and family-centered processes of care. Families received pre-admission care in several settings and described varying degrees of care coordination during their admission processes. This research can guide improvements in hospitals’ admission systems, necessary to achieve health system integration and continuity of care.
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影响因子：
8
作者：
Luo, XM;Liu, G;Hey, LA
通讯作者：
Hey, LA
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