Navigating tensions: integrating palliative care consultation services into an academic medical center setting.
Navigating tensions: integrating palliative care consultation services into an academic medical center setting.
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DOI：
10.1016/j.jpainsymman.2011.02.010
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发表时间：
2011-11
影响因子：
4.7
通讯作者：
Quill, Timothy E.
中科院分区：
文献类型：
--
作者：
Norton, Sally A.;Powers, Bethel Ann;Schmitt, Madeline H.;Metzger, Maureen;Fairbanks, Eileen;DeLuca, Jane;Quill, Timothy E.
关键词：
尽管迅速扩散的医院为基础的姑息治疗咨询服务（PCCS）在全国范围内，很少有描述的动态过程中，PCCS和非PCCS医院文化的经验，在一个成功的PCCS制度化。描述一个新的PCCS在四级护理学术医疗中心（AMC）的制度化，并强调两个主题，成本和质量，弥漫的动态参与从成立到成功整合的服务。使用纵向实地观察，深入访谈和文物收集的民族志。该研究是在美国东北部地区的一个750张床位的四级护理ACM中进行的。参与者是有目的地选择的样本（n = 79）（a）高级机构管理人员，包括护理，医学和社会工作的临床领导者，（B）经常或很少使用PCCS的临床医生，以及（c）PCCS核心和扩展团队的成员。有助于成功整合PCCS的关键基础设施组件包括：顶级跨专业行政买入的质量和成本参数PCCS，PCCS领导层的选择，强大的数据收集策略，强调质量的结果数据，通过“医生转诊只”规则，和增量和可持续的增长。从2003年到2009年，PCCS服务平均每年增长23%。深入了解成功的体制化的基础设施和进程之间的动态相互作用及其独特的复杂性，可能有助于其他PCCS确定和谈判其自身情况的属性，这将增加其成功和可持续实施的机会。
Despite rapid proliferation of hospital-based palliative care consultation services (PCCS) across the country, there is little description of the dynamic processes that the PCCS and the non-PCCS hospital cultures experience during the institutionalization of a successful PCCS. To describe the institutionalization of a new PCCS in a quaternary care academic medical center (AMC) and highlight two themes, cost and quality, that pervaded the dynamics involved from the inception to the successful integration of the service. Ethnography using longitudinal field observations, in-depth interviews, and the collection of artifacts. The study was performed in a 750-bed quaternary care ACM in the northeastern region of the U.S. Participants were a purposefully selected sample (n = 79) of (a) senior-level institutional administrators, including clinical leaders in nursing, medicine, and social work, (b) clinicians who used the PCCS, either commonly or rarely, and (c) members of the PCCS core and extended teams. Key infrastructure components that contributed to the successful integration of the PCCS included: top level interprofessional administrative buy-in to the quality and cost arguments for PCCS, PCCS leadership selection, robust data collection strategies emphasizing quality outcome data, the adoption of the “physician referral only” rule, and incremental and sustainable growth. The PCCS service has grown an average of 23% per year from 2003–2009. An in-depth understanding of the dynamic interaction of the infrastructures and processes of a successful institutionalization, in their unique complexity, may help other PCCSs identify and negotiate attributes of their own circumstances that will increase their chances for successful and sustainable implementation.
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影响因子：
2.8
作者：
Quill, Timothy;Norton, Sally;Buckley, Marsha
通讯作者：
Buckley, Marsha
DOI：
10.1177/1049909107310138
发表时间：
2008-04-01
影响因子：
1.9
作者：
Shah, Mindy;Quill, Timothy;Fridd, Charlotte
通讯作者：
Fridd, Charlotte
影响因子：
120.7
作者：
Hui, David;Elsayem, Ahmed;Bruera, Eduardo
通讯作者：
Bruera, Eduardo
影响因子：
4.7
作者：
Kutner, JS;Metcalfe, T;Seligman, PA
通讯作者：
Seligman, PA
DOI：
10.1177/104990910302000508
发表时间：
2003-09-01
期刊：
The American journal of hospice & palliative care
影响因子：
--
作者：
Nelson, Kristine A;Walsh, Declan
通讯作者：
Walsh, Declan