The diverse landscape of palliative care clinics.
The diverse landscape of palliative care clinics.
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姑息治疗诊所的多样化景观。
DOI：
10.1089/jpm.2012.0469
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发表时间：
2013
影响因子：
2.8
通讯作者：
Rabow,MichaelW
中科院分区：
文献类型：
--
作者：
Smith,AlexanderK;Thai,JulieN;Bakitas,MarieA;Meier,DianeE;Spragens,LynnH;Temel,JenniferS;Weissman,DavidE;Rabow,MichaelW
背景：许多卫生保健组织都有兴趣建立一个姑息治疗诊所。然而，有足够的公布数据，现有的做法，通知新programmes.Objective的发展：我们的目标是获得深入的信息姑息治疗clinics.Methods：我们进行了一项横断面调查，20个门诊姑息治疗的做法，在不同的护理环境。调查包括封闭式和开放式的问题，有关实践规模，利用服务，人员配备，转介，提供的服务，资金，动力开始，和challenges.Results：21（95%）的做法作出回应。自我认定为：基于医院（n=7）、肿瘤科/癌症中心（n=5）、综合卫生系统的一部分（n=6）和基于临终关怀（n=2）。大多数转诊患者都有癌症诊断。其他常见的诊断包括慢性阻塞性肺病、神经系统疾病和充血性心力衰竭。所有的实践都将“疼痛管理”和“确定护理目标”列为转诊的最常见原因。有12个诊所每周工作不到5个半天，有7个诊所每周只工作半天。实践工作人员由医生，高级执业护士或执业护士，护士或社会工作者的混合物。有18个业务部门预计其业务在明年内将有所增长。11个诊所指出人手短缺，8个诊所等待新病人预约的时间为一周或更长。只有12家诊所提供全天候服务。账单和机构支助是最常见的资金来源。大多数的做法描述开始，因为住院姑息治疗提供者认为质量差的门诊治疗在门诊设置。最常见的挑战包括：人员配备资金（11）和被转诊（8）。结论：一旦建立，门诊姑息治疗的做法预计迅速增长。在这种情况下，门诊实践必须计划增加人员配置，并制定可持续的财务模式。
Background:Many health care organizations are interested in instituting a palliative care clinic. However, there are insufficient published data regarding existing practices to inform the development of new programs.Objective:Our objective was to obtain in-depth information about palliative care clinics.Methods:We conducted a cross-sectional survey of 20 outpatient palliative care practices in diverse care settings. The survey included both closed- and open-ended questions regarding practice size, utilization of services, staffing, referrals, services offered, funding, impetus for starting, and challenges.Results:Twenty of 21 (95%) practices responded. Practices self-identified as: hospital-based (n=7), within an oncology division/cancer center (n=5), part of an integrated health system (n=6), and hospice-based (n=2). The majority of referred patients had a cancer diagnosis. Additional common diagnoses included chronic obstructive pulmonary disease, neurologic disorders, and congestive heart failure. All practices ranked “pain management” and “determining goals of care” as the most common reasons for referrals. Twelve practices staffed fewer than 5 half-days of clinic per week, with 7 operating only one half-day per week. Practices were staffed by a mixture of physicians, advanced practice nurses or nurse practitioners, nurses, or social workers. Eighteen practices expected their practice to grow within the next year. Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage. Billing and institutional support were the most common funding sources. Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing (11) and being overwhelmed with referrals (8).Conclusions:Once established, outpatient palliative care practices anticipate rapid growth. In this context, outpatient practices must plan for increased staffing and develop a sustainable financial model.