"At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19.
"At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19.
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DOI：
10.1111/jgs.16952
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发表时间：
2021-03
影响因子：
6.3
通讯作者：
Federman AD
中科院分区：
文献类型：
--
作者：
Franzosa E;Gorbenko K;Brody AA;Leff B;Ritchie CS;Kinosian B;Ornstein KA;Federman AD
COVID-19需要整个医疗保健系统的快速创新。以家庭为基础的初级保健（HBPC）的做法面临着独特的挑战，维持医疗复杂的老年人口的服务，他们需要适应传统的动手，护理模式，以适应限制在人接触。我们的目标是确定纽约城区HBPC实践在COVID-19大流行的第一波期间提供患者护理的策略，目标是为全国范围内的家庭实践提供规划和准备。采用半结构化访谈和归纳演绎主题分析的横断面定性设计。HBPC于2020年春季在纽约市（NYC）大都会区开展业务。HBPC领导层，包括临床/医疗主任，项目经理，执业护士/护理协调员和社会工作者/社会工作协调员（n=13）在6个纽约地区的做法。与会者描述了与2019冠状病毒病期间医疗机构普遍采用的护理服务和运营调整类似的护理服务和运营调整，例如患者外展和远程医疗。HBPC的具体调整包括为经历抑郁和孤立的患者提供心理健康服务，使用多种患者互动模式来平衡虚拟护理与必要的面对面接触，保持患者信任的策略，以及通过日常聚会支持工作人员的团队连接和长期患者死亡激增期间的情感支持。在COVID-19疫情高峰期间，纽约地区HBPC提供商迅速调整了护理服务和运营。让老年人、病情复杂的病人在家中安全地生活需要相当大的灵活性、透明度、团队精神以及与外部提供者的伙伴关系。随着美国各地疫情持续激增，HBPC提供商可能会应用这些教训并考虑为应对未来挑战做好准备所需的资源。
COVID-19 required rapid innovation throughout the health care system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. Cross-sectional qualitative design using semi-structured interviews and inductive and deductive thematic analysis. HBPC practices in the New York City (NYC) metro area during spring 2020. HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators and social workers/social work coordinators (n=13) at 6 NYC-area practices. Participants described care delivery and operational adaptations similar to those universally adopted across health care settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork and partnerships with outside providers. As the pandemic continues to surge around the US, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.
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影响因子：
4.7
作者：
Ranganathan, C.;Balaji, S.
通讯作者：
Balaji, S.
影响因子：
6.3
作者：
Edes, Thomas;Kinosian, Bruce;Hossain, Monir
通讯作者：
Hossain, Monir
影响因子：
0.5
作者：
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通讯作者：
Ackerman, Marra G.
DOI：
10.1017/s0714980820000203
发表时间：
2020-09-01
影响因子：
1.9
作者：
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通讯作者：
Wilson, Kimberley
影响因子：
3.8
作者：
Bartels, Stephen J.;Baggett, Travis P.;Bird, Bruce L.
通讯作者：
Bird, Bruce L.