Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration
Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration
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DOI：
10.1093/geront/gnx096
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发表时间：
2018-08-01
期刊：
影响因子：
5.7
通讯作者：
Intrator, Orna
中科院分区：
文献类型：
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作者：
Miller, Edward Alan;Gidmark, Stefanie;Intrator, Orna
背景和目标：退伍军人进入疗养院 (NH) 进行短期急性后期、康复、暂息或临终护理。他们还因虚弱、残疾、功能缺陷和认知障碍而长期进入NHs。一旦决定进入 NH，人们对如何选择特定 NH 知之甚少。这项研究确定了 VA 工作人员对影响退伍军人健康管理局 (VHA) 内 NH 搜索和选择的关键因素的看法。研究设计和方法：数据来自对 12 个退伍军人事务医疗中心 (VAMC) 的出院计划和签约人员进行的 35 次半结构化访谈。结果：VA 工作人员在 NH 选择过程中非常重视退伍军人和家庭的偏好，尽管 VA 工作人员对安置选项的了解和熟悉程度确定了 NH 安置的一般参数做出了决定。地理位置靠近退伍军人的家园和家人是选择新罕布什尔州的一个主要因素。其他关键考虑因素包括退伍军人的特殊护理需求（精神科、急性后护理、呼吸机）和退伍军人/设施人口统计数据（年龄、种族/民族、退伍军人身份）。 VA 工作人员试图在 NH 选择中保持中立，从而指导家庭参观设施并审查公开的质量数据。 VA 工作人员报告说，在退伍军人和家庭决策中，便利设施（私人房间、活动、吸烟）和美观（清洁度、气味、布局、装饰）常常超过客观质量指标。讨论和启示：调查结果表明，VAMC 有助于退伍军人和家庭围绕 NH 选择做出决策。他们还建议 VAMC 努力寻找和招募更多高质量的 NH，以更好地将退伍军人和家庭的具体需求与可用的选择相匹配。
Background and Objectives: Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA).Research Design and Methods: Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs).Results: VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, decor) often outweighed objective quality indicators in Veteran and family decision making.Discussion and Implications: Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.