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.

项目概要 在美国，超过 47,000 名透析患者护理技术人员 (PCT) 负责技术 管理近 500,000 名患者的中心血液透析 (HD)。透析 PCT 的权威 执行其他临床任务因州而异，但将不适当的任务委派给他人可能是常见的做法 透析 PCT。事实上，全国透析诊所拥有执照的实用/职业护士人数不足 5000 名。 2018 年，表明透析 PCT 可能提供大部分医疗护理，否则这些医疗护理可能会 分配给这些护士。此外，相对于其他团队成员，PCT 花在患者身上的时间最多 在透析诊所中，提供了一个利用透析 PCT 来提高透析质量的明显机会 整体透析护理。即使拥有强制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 在美国仍然难以捉摸。我们的首要目标是探索透析 PCT 在透析中的作用 护理，为未来通过参与 PCT 来提高透析环境中整体护理质量的努力提供信息。瞄准 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、 随着时间的推移，开放的 PCT 职位百分比、PCT：患者和 PCT：其他员工比例）并进行探索 该人员配置与患者结果的关联（例如住院、死亡率、移植和候补， 使用定量方法。在目标 2 中，我们将探讨对角色的看法 透析 PCT 的能力和能力、PCT 培训干预的优先事项以及其潜在障碍 采用定性方法实施。具体来说，我们将开展六个焦点小组（每个小组 6-8 人） 跨学科透析护理团队成员（两名具有 PCT；两名具有医生、护士、社会工作者、 营养师和管理人员；两个中心内 HD 患者）以确定培训需求的优先顺序并确定问题 （例如，沟通、文化能力、以人为本的护理服务、组织文化） 使 PCT 成为透析护理团队的重要成员。这项提议的形成性 使用二手数据分析和定性数据收集的研究将增加我们对 透析 PCT 人员配置及其与患者结果的潜在关联；超出的护理量 正在或可能由透析 PCT 提供的血液透析技术管理；和感知到的 透析 PCT 是否有足够的培训和知识来提供这种护理。初步收集的数据 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 护理团队更好地参与透析 PCT——最终实现整合、协调的全人、360° 程度护理，以优化不成比例的低收入人群的个人和人口健康结果 以及接受中心 HD 治疗的少数族裔和老年美国患者。

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