Uncovering Caregiver Discharge Readiness for Patient Care Transitions from Hospital to Home: The UCare Study

项目总结 在美国，每五个人中就有一个，即5300万人，目前担任无偿照顾者。 护理人员通过在医疗保健系统中导航，直接为患者的安全和健康结果做出贡献， 管理复杂的护理，倡导满足患者的需求。在医院的高风险过程中 出院，照顾者的参与支持准备和护理的连续性；减少准备 出院照顾者会增加再次入院的风险。CMS需要进行以下教育 患者、家人、监护人和/或照顾者关于自我管理、独立生活和日常活动的信息 为了获得“护理管理”服务的报销，已有30多个州通过了 护理员建议记录启用(CARE)法案要求护理员积极参与出院计划 和教育。然而，没有唯一的结果衡量标准来评估准备得有多充分 照顾者出院后，照顾者应参与照看活动。当前的措施 照顾者1)只关注照顾者的一般结果，如身体和精神健康，2)是 为过渡期护理质量与现实世界临床中及时应用的回顾报告而开发 环境，或3)缺乏严格的心理测试报告。简而言之，目前的措施并不能 看护人员在医院高危事件中对自身准备水平的具体认知 出院。因此，卫生系统缺乏评估出院效果的实际措施。 照顾者的准备，而我们对照顾者的准备情况没有确切的理解 为患者安全过渡回家作出贡献。这项研究的目标是开发和测试一种测量方法， 捕捉对照顾者准备从事照看的感觉重要的独特因素。使用 混合方法的方法，本研究的具体目的是1)开发一个有理论基础和 心理健康照顾者出院就绪量表(FamRHDS-R)；2)建立 新的FAMRHDS-R的心理测量学特性和测量不变性；以及3)确定是否和 新的FamRHDS-R如何与一系列照顾者和患者的结果相关联。整体而言 假设是，新的FamRHDS-R衡量标准评估照顾者参与照看准备的意愿 捕捉并解释出院后患者和照顾者结局的变异性。因为这项研究是 响应卫生系统和护理人员的需求，并寻求完善和测试基于 已经在全国超过35个卫生系统实施的措施，这项非常有意义的研究很好 定位为对医院出院质量和健康结果产生重大影响，包括 重新入院和护理总费用。

PROJECT SUMMARY One in five individuals, or 53 million people, are currently acting as unpaid caregivers in the United States. Caregivers directly contribute to patient safety and health outcomes by navigating health care systems, managing complex care, and advocating for the needs of patients. During the high-risk process of hospital discharge, caregiver involvement supports preparedness and continuity of care; decreased preparedness of caregivers for discharge results in an increased risk for readmission to the hospital. CMS requires education of patients, family, guardians, and/or caregivers about self-management, independent living, and activities of daily living in order to be reimbursed for “care management” services, and more than 30 states have adopted the Caregiver Advise Record Enable (CARE) Act requiring active engagement of caregivers in discharge planning and education. However, there is no unique outcome measure available to assess how well-prepared caregivers are to engage in caregiving activities after care recipients’ hospital discharge. Current measures of caregivers 1) focus exclusively on general caregiver outcomes such as physical and mental wellbeing, 2) were developed for retrospective reporting of transitional care quality vs timely application in real world clinical settings, or 3) lack rigorous reporting of psychometric testing. Simply put, current measures don’t capture caregivers’ specific perceptions about their own level of preparedness during the high-risk event of hospital discharge. As a result, health systems lack a practical measure for assessing the effectiveness of discharge preparation of caregivers, and we are left without a firm understanding of how caregiver readiness may contribute to patients’ safe transitions home. The goal of this study is to develop and test a measure that captures the unique factors important to caregivers’ feelings of readiness to engage in caregiving. Using a mixed-methods approach, the specific aims of this study are to 1) develop a theoretically grounded and psychometrically sound caregiver hospital discharge readiness scale (FamRHDS-R); 2) establish the psychometric properties and measurement invariance of the new FamRHDS-R; and 3) establish whether and how the new FamRHDS-R is associated with a range of caregiver and patient outcomes. The overall hypothesis is that the new FamRHDS-R measure assessing caregiver readiness to engage in caregiving will capture and explain variability in post-discharge patient and caregiver outcomes. Because this study is responsive to the needs of both health systems and caregivers, and seeks to refine and test a tool based on measures already implemented in over 35 health systems nationwide, this highly significant study is well positioned to substantially impact hospital discharge quality and health outcomes including reduced readmissions and overall costs of care.