Hospitalized older adults' care transition: themes, symptoms, QoL, and utilizatio

住院老年人的护理转变：主题、症状、生活质量和利用

• 批准号: 8454954
• 负责人: Carol Reynolds Geary
• 金额: $ 3.33万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-26 至 2015-09-25
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8454954
• 关键词: Accident and Emergency department; Address; Advanced Malignant Neoplasm; Affect; Area; Back; Behavior; Care given by nurses; Caregivers; Caring; Case Study; Chronic Disease; Clinical; Complex; Data; Data Collection; Distress; Elderly; Environment; Event; Failure; Fee-for-Service Plans; Foundations; Health; Health Care Reform; Health Personnel; Healthcare; Healthcare Systems; Heart Diseases; Hospitals; Individual; Inpatients; Intervention; Interview; Left; Life; Measures; Medical Records; Medicare; Methods; Mission; Movement; Nature; Nurses; Nursing Homes; Outcome; Outcomes Research; Patient Care; Patient Discharge; Patient-Focused Outcomes; Patients; Pattern; Physician Executives; Population; Probability; Process; Provider; Psychological adjustment; Quality of life; Registered nurse; Rehabilitation therapy; Research; Research Design; Research Personnel; Resources; Risk; Science; Scientist; Skilled Nursing Facilities; Source; Staging; Symptoms; System; Systems Development; Time; Training; Universities; Visit; base; care systems; contextual factors; cost; design; emotional adjustment; experience; health care service utilization; high risk; hospital readmission; improved; innovation; older patient; patient oriented; pre-doctoral; prospective; public health relevance; shift work; statistics; symptom management; therapy development

DESCRIPTION (provided by applicant): This is a study of care transitions experienced by older adults with advanced chronic illness using complexity science as the conceptual framework. The purpose is to describe, from multiple perspectives, care transitions from hospital to a nursing home for skilled care and for the first 120 days following, including additional transitions that may occur. Aims of the study are to describe care transitions from the perspectives of patients, informal caregivers, and health care providers; to explore trajectories i patient quality of life and symptoms related to health care utilization (e.g., ER visits and hospitl readmissions); and to better understand patterns in the complexity of care transitions through cross-case comparison including both the qualitative themes and the quantitative measures. This prospective, mixed methods study will use multiple case studies with an embedded quantitative strand and multiple sources of information including interview, observation, and medical records review. Research that encompasses both patient and health care provider perspectives is highly significant in this era of health care reform and patient-centered outcomes research. Research completed to date is narrow in focus: addressing only patient symptoms and quality of life or system variables, such as readmission. In addition, research on the transition from hospital to skilled nursing care is limited both in quantity and scope. This result in a view of care transitions that does not adequately inform research or practice. An in-depth description of patients' care transition experiences from multiple perspectives across time is needed. The tenets of complexity science have informed study design and methods including the prospective nature of the study, data collection from multiple sources, and the incorporation of both qualitative and quantitative data. This study will provide a rich description of each patiet and his or her transition(s). Included are qualitative descriptions of the patients', caregivers' ad HCPs' perspectives, with quantitative patient-focused measures (QoL and symptoms) and systems-based measures (ER visits and hospital readmissions). This design allows the capture of the complexity of transition as well as the array of events, both clinical and context-based, that affect the decision to transfer. This unprecedented view will inform the development of interventions to improve care and decrease unnecessary utilization. As a key component of pre-doctoral training at a research-intensive university, this study will lay the foundation for a carer as an academic nurse scientist during an era of major reform in the U.S. health care system. It synthesizes a focus on NINR's mission to advance the science of symptom management and quality of life in patients with advanced, life-limiting conditions with the national imperative to make the U.S. health care system more patient-centered.

描述（由申请人提供）：这是一项使用复杂性科学作为概念框架的老年慢性病患者所经历的护理过渡研究。其目的是从多个角度描述从医院到疗养院的护理过渡，以进行专业护理，以及随后的前120天，包括可能发生的其他过渡。该研究的目的是从患者、非正式护理人员和医疗保健提供者的角度描述护理转变;探索患者生活质量的轨迹和与医疗保健利用相关的症状（例如，急诊室访问和医院再入院），并通过跨案例比较，包括定性主题和定量措施，以更好地了解模式的复杂性护理过渡。这项前瞻性的混合方法研究将使用多个病例研究，其中包含嵌入式定量链和多个信息来源，包括访谈，观察和病历审查。在这个医疗改革和以病人为中心的结果研究的时代，包括病人和医疗保健提供者的观点的研究是非常重要的。迄今为止完成的研究重点很窄：仅解决患者症状和生活质量或系统变量，如再入院。此外，从医院到熟练的护理过渡的研究是有限的数量和范围。这导致在护理过渡的观点，没有充分告知研究或实践。需要从多个角度跨时间深入描述患者的护理过渡体验。复杂性科学的原则为研究设计和方法提供了信息，包括研究的前瞻性，从多个来源收集数据，以及定性和定量数据的结合。这项研究将提供一个丰富的描述每个patiet和他或她的过渡（S）。包括对患者、护理人员和HCP观点的定性描述，以及以患者为中心的定量指标（QoL和症状）和基于系统的指标（ER访视和再次入院）。这种设计允许捕获转移的复杂性以及影响转移决策的一系列事件，包括临床和基于背景的事件。这一前所未有的观点将为制定干预措施以改善护理和减少不必要的利用提供信息。作为在研究密集型大学博士前培训的一个关键组成部分，这项研究将奠定护理人员作为一个学术护理科学家在美国医疗保健系统的重大改革时代的基础。它综合了对NINR的使命的关注，以推进症状管理的科学和晚期患者的生活质量，生命限制条件与国家的当务之急， 使美国医疗保健系统更加以患者为中心。