Role of the Patient Care Technician in Dialysis

患者护理技术人员在透析中的作用

• 批准号: 10704148
• 负责人: Laura Plantinga
• 金额: $ 5万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704148
• 关键词: Role; Patient; Care; Technician; Dialysis

PROJECT SUMMARY In the United States, >47,000 dialysis patient care technicians (PCTs) are responsible for the technical management of in-center hemodialysis (HD) for nearly 500,000 patients. The authority for dialysis PCTs to perform other clinical tasks varies by state, but it may be common practice to delegate inappropriate tasks to dialysis PCTs. In fact, there were <5000 licensed practical/vocational nurses nationwide in dialysis clinics in 2018, suggesting that dialysis PCTs are likely providing much of the medical care that might otherwise be assigned to these nurses. Further, relative to other team members, PCTs spend the most time with patients in the dialysis clinic, presenting a clear opportunity to engage dialysis PCTs in improving the quality of dialysis care overall. Even with mandated interdisciplinary dialysis care teams and ongoing national quality improvement efforts that are tied to reimbursement, delivery of high-quality, patient-centered dialysis care remains elusive in the United States. Our overarching goal is to explore the role of the dialysis PCT in dialysis care, informing future efforts to increase overall quality of care in the dialysis setting by engaging PCTs. In Aim 1, we will use national administrative data describe patterns of dialysis PCT staffing (e.g., number of PCTs, percentage of PCT positions that are open, PCT:patient and PCT:other staff ratios) over time and explore associations of this staffing with patient outcomes (e.g., hospitalization, mortality, transplant and waitlisting, permanent vascular access use) using quantitative methods. In Aim 2, we will explore perceptions of the roles and abilities of the dialysis PCT, priorities for PCT training interventions, and potential barriers to their implementation using qualitative methods. Specifically, we will conduct six focus groups (n=6-8 each) with interdisciplinary dialysis care team members (two with PCTs; two with physicians, nurses, social workers, dietitians, and administrators; two with in-center HD patients) to prioritize training needs and identify issues (e.g., communication, cultural competency, person-centered care delivery, organizational culture) that will need to be addressed for PCTs to become valued comembers of the dialysis care team. This proposed formative study, using both secondary data analysis and qualitative data collection, will increase our understanding of dialysis PCT staffing and its potential association with patient outcomes; the amount of care beyond the technical management of hemodialysis that is being, or could be, provided by dialysis PCTs; and the perceived adequacy of training and knowledge among dialysis PCTs to provide that care. The preliminary data collected here will directly inform future studies that will lay the groundwork to improve the ability of the entire dialysis care team to better engage dialysis PCTs—ultimately leading to integrated, coordinated whole-person, 360- degree care to optimize individual and population health outcomes among the disproportionately low-income and minority and older U.S. patients who receive in-center HD.

项目摘要 在美国，超过47，000名透析患者护理技术人员（PCT）负责技术 为近50万名患者提供中心内血液透析（HD）管理。透析PCT的权威机构， 执行其他临床任务因州而异，但将不适当的任务委托给 透析PCT。事实上，2010年全国透析诊所有不到5000名有执照的实习/职业护士。 2018年，这表明透析PCT可能会提供大部分的医疗护理，否则可能会 分配给这些护士此外，相对于其他团队成员，PCT与患者相处的时间最多 在透析诊所，提供了一个明确的机会，使透析PCT在提高质量， 整体透析护理。即使有授权的跨学科透析护理团队和持续的国家质量 与报销、提供高质量、以患者为中心的透析护理相关的改进工作 在美国仍然是难以捉摸的。我们的首要目标是探索透析PCT在透析中的作用 护理，告知未来的努力，以提高整体质量的护理，在透析设置通过聘请PCT。在Aim中 1，我们将使用国家管理数据描述透析PCT人员配置模式（例如，PCT数量， PCT职位空缺的百分比、PCT：患者和PCT：其他工作人员比率），并探索 这种人员配备与患者结果的关联（例如，住院率、死亡率、移植和等待名单， 永久性血管通路使用）。在目标2中，我们将探讨对角色的看法 和透析PCT的能力，PCT培训干预的优先事项，以及他们的潜在障碍。 采用定性方法。具体而言，我们将进行六个焦点小组（每组n=6-8）， 跨学科透析护理团队成员（两名与PCT;两名与医生，护士，社会工作者， 营养师和管理人员;两名中心HD患者），以确定培训需求的优先顺序并确定问题 (e.g.,沟通，文化能力，以人为本的护理服务，组织文化），将需要 使PCT成为透析护理团队的重要成员。这一建议的形成 研究，使用二手数据分析和定性数据收集，将增加我们的理解， 透析PCT人员配备及其与患者结局的潜在关联; 正在或可能由透析PCT提供的血液透析技术管理;以及 透析PCT提供护理的培训和知识的充分性。收集的初步数据 这里将直接告知未来的研究，为提高整个透析的能力奠定基础。 护理团队，以更好地参与透析PCT-最终导致集成，协调的全人，360- 在不成比例的低收入人群中， 以及接受中心HD的少数民族和老年美国患者。

项目成果

Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study.

美国血液透析设施的患者护理技术人员配备：一项生态研究。

• DOI: 10.1016/j.xkme.2023.100782
• 发表时间: 2024
• 期刊: Kidney medicine
• 影响因子: 3.9
• 作者: Plantinga,LauraC;Urbanski,Megan;Hoge,Courtney;Rickenbach,Fran;Douglas-Ajayi,Clarica;Morgan,JenniferCraft;Bender,AlexisA;Jaar,BernardG
• 通讯作者: Jaar,BernardG