Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care
Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care
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DOI：
10.1007/s11606-017-4298-1
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发表时间：
2018-05-01
影响因子：
5.7
通讯作者：
Cumbler, Ethan
中科院分区：
文献类型：
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作者：
Burke, Robert E.;Jones, Jacqueline;Cumbler, Ethan
尽管最近的支付改革带来了全国对急性后护理的关注，但对于住院老年人及其照顾者在住院后如何决定是否前往熟练护理机构(SNF)，我们知之甚少。我们试图了解住院老年人及其照顾者在多大程度上有权就利用SNF进行急性后护理做出高质量的决定，以及哪些上下文或流程元素在SNF中导致了他们对决定结果的满意度。使用渥太华决策支持框架(ODSF)进行定性查询，描述高质量决策关键组成部分的概念框架。32名以前居住在社区的老年人(>；=65岁)和22名护理人员在三家不同的医院和三家技术熟练的护理机构接受采访。我们使用ODSF的关键组成部分来确定影响决策的背景和过程的要素，以及高质量决策的结果特征在多大程度上：知情的、基于价值观的、与遗憾或责备无关的。最重要的背景主题是医院中存在使决策困难的活跃的医疗条件、以前再次住院或SNF的经历、护理人员支持的相对水平，以及迅速做出参与者感到准备不足的决策的压力。患者描述说，他们在决策过程中扮演着被动的角色，在很大程度上依赖于医疗团队的建议。患者通常表现出听天由命和缺乏选择或自主的感觉，导致对结果的不满。理解和干预以提高关于急性后护理支持的决策质量对于改善住院老年患者的预后至关重要。我们的结果表明，仅仅提供信息是不够的；相反，纳入关键的背景因素并改善患者和临床医生的决策过程也是必不可少的。
Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization.We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF.Qualitative inquiry using the Ottawa Decision Support Framework (ODSF), a conceptual framework that describes key components of high-quality decision-making.Thirty-two previously community-dwelling older adults (>= 65 years old) and 22 caregivers interviewed at three different hospitals and three skilled nursing facilities.We used key components of the ODSF to identify elements of context and process that affected decision-making and to what extent the outcome was characteristic of a high-quality decision: informed, values based, and not associated with regret or blame.The most important contextual themes were the presence of active medical conditions in the hospital that made decision-making difficult, prior experiences with hospital readmission or SNF, relative level of caregiver support, and pressure to make a decision quickly for which participants felt unprepared. Patients described playing a passive role in the decision-making process and largely relying on recommendations from the medical team. Patients commonly expressed resignation and a perceived lack of choice or autonomy, leading to dissatisfaction with the outcome.Understanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential.