Improving the Quality of Home Health Care for Children With Medical Complexity
Improving the Quality of Home Health Care for Children With Medical Complexity
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DOI：
10.1016/j.acap.2017.04.019
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发表时间：
2017-08-01
影响因子：
3.1
通讯作者：
Golden, Shannon L.
中科院分区：
文献类型：
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作者：
Nageswaran, Savithri;Golden, Shannon L.
目的：本研究的目的是描述家庭医疗保健服务的质量为儿童的医疗复杂性，确定障碍，提供最佳的家庭医疗保健，并讨论潜在的解决方案，以改善家庭医疗保健服务。在这项质性研究中，我们对20名患有医学复杂性的儿童的主要照顾者进行了半结构化的深入访谈，和4个焦点小组，18名家庭保健护士。在一个迭代分析过程中，我们确定了主题相关的家庭health care.RESULTS质量：有很大的差异之间的家庭保健护士在提供家庭保健儿童。护士缺乏技能是常见的，对具有医疗复杂性的儿童产生严重的负面健康后果，包括住院，急诊室就诊和需要医疗程序。家庭保健不足也加重了照顾者的负担。提供最佳家庭保健的一个主要障碍是家庭保健护士缺乏儿科护理和技术使用方面的培训。改善护理的潜在解决方案包括家庭保健机构培训护士护理具有医疗复杂性的儿童，支持护士解决临床问题，以及报销培训护士儿科家庭护理的费用。照顾者水平的干预措施，包括准备照顾者：提供医疗，照顾他们的孩子在家里，并解决问题与家庭health care service.CONCLUSIONS：有问题的家庭医疗保健的质量提供给儿童的医疗复杂性。培训护士照顾儿童的医疗复杂性和准备照顾家庭，照顾可以提高家庭保健质量。
OBJECTIVE: The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery.METHODS: In this qualitative study, we conducted 20 semi structured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care.RESULTS: There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical, care for their children at home and addressing problems with home health care services.CONCLUSIONS: There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home, care could improve home health care quality.