Improving integrated care for older people with frailty and their carers: An ethnographic study of medicines-related care within an integrated care pa
改善体弱老年人及其护理人员的综合护理:综合护理中心内药物相关护理的人种学研究
基本信息
- 批准号:1916683
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:英国
- 项目类别:Studentship
- 财政年份:2017
- 资助国家:英国
- 起止时间:2017 至 无数据
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
BackgroundIntegrated care pathways (ICPs) are 'locally developed, multidisciplinary infrastructural technologies that map core interventions in a clinical trajectory and are simultaneously a workflow system and a record of care' (Allen 2014: 808). ICPs have been widely used to improve quality and equity of care for patients with a range of health conditions. They have been proposed as a vehicle for clinical governance (Degeling et al 2005), embedding evidence based guidelines into clinical practice (Allen 2014), and health care policy. However, there has been limited social science research focusing on a critical understanding of the role, value and implications of ICPs from different stakeholder perspectives, and the social, organisational, politico-economic and historical contexts shaping their emergence, development and implementation in practice.This PhD study will explore these issues in the context of ICPs for frail older people in Lambeth and Southwark, South London. Frail older are high users of health and social care services, but report difficulties receiving care efficiently and in a coordinated manner, and are at high risk of receiving poor quality of care due to fragmented service provision (Ament et al 2014). Although a number of ICPs for frail older people are being developed, evaluated and commissioned locally in the UK, little is known about different stakeholders' perspectives of the benefits, limitations and unintended consequences of ICPs, and the contexts shaping their development and implementation in practice. Aims 1) To examine the social, organisational, politico-economic and historical contexts shaping the emergence, development and implementation of ICPs for frail older people; 2) To explore how ICPs for frail older people in Lambeth and Southwark, South London are currently being delivered and implemented on the ground; 3) To explore how frail older people and their family carers, and different provider and organisational stakeholders perceive ICPs, including their role, value, limitations and implications. 4) To synthesise knowledge from 1-3 to co-design clearer pathways and inform a framework to facilitate the implementation of ICPs, that meet the needs of what is important to frail older people, and improve quality of care and outcomes for frail older people in Lambeth and Southwark, South London. Methods The study will use a mixed-methods design: 1) A genealogical analysis of health care policy of the historical and politico-economic discourses, practices and contexts shaping the emergence of ICPs for frail older people. 2) An ethnographic study to explore how ICPs for frail older people in Lambeth and Southwark, South London are currently delivered locally. This will involve observations of care practices with a sample of frail older people and their family members as they navigate the health and care system, analysis of care records, interviews with participants and professionals involved in their care and pathway mapping. 3) Co-design methodology will subsequently be applied through a series of group workshops with a range of stakeholders to develop clearer pathways and a framework to facilitate the implementation of ICPs to improve quality of care and outcomes for frail older people. References Allen D. (2014) Lost in translation? 'Evidence' and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object? Sociology of Health & Illness, 36, 6: 807- 822. Ament B, de Vugt M, Verhey F, Kempen G. (2014) Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social and psychological frailty? European Journal of Ageing, 11: 213-219. Degeling P, Maxwell S, Ledema, R. (2004) Restructuring clinical governance to maximise developmental potential. In Gray A, Harrison S (eds) Governing Medicine: Theory and Practice. Oxford: Oxford University Press.
背景综合护理路径(ICP)是“本地开发的多学科基础设施技术,其在临床轨迹中映射核心干预措施,同时是工作流程系统和护理记录”(艾伦2014:808)。ICP已被广泛用于改善各种健康状况患者的护理质量和公平性。它们已被提议作为临床管理的工具(Degeling et al 2005),将循证指南嵌入临床实践(艾伦2014)和医疗保健政策。然而,已经有有限的社会科学研究侧重于从不同的利益相关者的角度,以及社会,组织,政治经济和历史背景塑造他们的出现,发展和实施的关键理解ICP的作用,价值和影响,在practice.This博士研究将探讨这些问题的ICP为体弱的老年人在兰贝斯和南华克,南伦敦的背景下。体弱老年人是卫生和社会护理服务的高用户,但报告难以以协调的方式有效地接受护理,并且由于服务提供分散,他们接受护理质量差的风险很高(Ament等人,2014年)。虽然一些针对体弱老年人的综合社区方案正在英国当地开发、评估和委托,但人们对不同利益攸关方对综合社区方案的好处、局限性和意外后果的看法以及在实践中形成其开发和实施的背景知之甚少。目的1)研究影响体弱老年人综合社区方案的出现、发展和实施的社会、组织、政治经济和历史背景; 2)探讨伦敦南部兰贝斯和萨瑟克的体弱老年人综合社区方案目前是如何在实地交付和实施的; 3)探讨体弱长者及其家人照顾者,以及不同的提供者和组织利益相关者如何看待ICP,包括其作用,价值,局限性和影响。4)综合1-3人的知识,共同设计更清晰的路径,并为促进ICP实施的框架提供信息,以满足对体弱老年人来说重要的需求,并提高兰贝斯和伦敦南部萨瑟克区体弱老年人的护理质量和结果。伦敦。方法本研究将采用混合方法设计:1)对形成老年人ICP出现的历史和政治经济话语、实践和背景的卫生保健政策进行系谱分析。2)一项民族志研究,探讨如何为兰贝斯和南华克,南伦敦虚弱的老年人ICP目前提供本地。这将涉及观察护理实践与体弱的老年人及其家庭成员的样本,因为他们浏览的健康和护理系统,护理记录的分析,参与者和专业人员参与他们的护理和路径映射的采访。3)随后将通过与一系列利益攸关方举行的一系列小组研讨会应用共同设计方法,以制定更明确的途径和框架,促进实施综合方案,提高体弱老年人的护理质量和成果。 参考文献艾伦D. 2014年,《迷失在翻译中》(Lost in Translation?综合护理路径中的“证据”和制度逻辑的表达:从积极到消极的边界对象?健康与疾病社会学,36,6:807- 822。Ament B,de Vugt M,Verhey F,Kempen G.(2014年)身体虚弱的老年人如果同时患有认知、社会和心理脆弱,是否更有可能出现不良后果?欧洲老龄化杂志,11:213-219。杨文,麦克斯韦文,杨文.(2004)重组临床治理,以最大限度地发挥发展潜力。在格雷A,哈里森S(编辑)管理医学:理论与实践。牛津:牛津大学出版社.
项目成果
期刊论文数量(4)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
The contribution of implementation science to improving the design and evaluation of integrated care programmes for older people with frailty
- DOI:10.1108/jica-07-2018-0048
- 发表时间:2019-06-20
- 期刊:
- 影响因子:0.8
- 作者:Sadler, Euan;Sandall, Jane;Wilson, Dan
- 通讯作者:Wilson, Dan
Influence of external contextual factors on the implementation of health and social care interventions into practice within or across countries-a protocol for a 'best fit' framework synthesis.
外部环境因素对在国家内部或跨国实施健康和社会护理干预措施的影响——“最适合”框架综合的协议。
- DOI:10.1186/s13643-019-1180-8
- 发表时间:2019
- 期刊:
- 影响因子:3.7
- 作者:Ziemann A
- 通讯作者:Ziemann A
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其他文献
吉治仁志 他: "トランスジェニックマウスによるTIMP-1の線維化促進機序"最新医学. 55. 1781-1787 (2000)
Hitoshi Yoshiji 等:“转基因小鼠中 TIMP-1 的促纤维化机制”现代医学 55. 1781-1787 (2000)。
- DOI:
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- 影响因子:0
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LiDAR Implementations for Autonomous Vehicle Applications
- DOI:
- 发表时间:
2021 - 期刊:
- 影响因子:0
- 作者:
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吉治仁志 他: "イラスト医学&サイエンスシリーズ血管の分子医学"羊土社(渋谷正史編). 125 (2000)
Hitoshi Yoshiji 等人:“血管医学与科学系列分子医学图解”Yodosha(涉谷正志编辑)125(2000)。
- DOI:
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Effect of manidipine hydrochloride,a calcium antagonist,on isoproterenol-induced left ventricular hypertrophy: "Yoshiyama,M.,Takeuchi,K.,Kim,S.,Hanatani,A.,Omura,T.,Toda,I.,Akioka,K.,Teragaki,M.,Iwao,H.and Yoshikawa,J." Jpn Circ J. 62(1). 47-52 (1998)
钙拮抗剂盐酸马尼地平对异丙肾上腺素引起的左心室肥厚的影响:“Yoshiyama,M.,Takeuchi,K.,Kim,S.,Hanatani,A.,Omura,T.,Toda,I.,Akioka,
- DOI:
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{{ truncateString('', 18)}}的其他基金
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