Role of the Patient Care Technician in Dialysis

项目总结 在美国，47,000名透析患者护理技术人员(PCT)负责技术 为近500,000名患者提供中心内血液透析(HD)管理。透析PCTS的授权 执行其他临床任务因州而异，但将不适当的任务委派给 透析PCT。事实上，在#年，全国有5000名执业/职业护士在透析诊所工作。 2018年，这表明透析PCT可能提供原本可能提供的大部分医疗服务 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，提供了一个明确的机会，让透析PCT参与提高透析质量 整体的透析护理。即使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，告知未来通过使用PCT来提高透析环境中的整体护理质量的努力。在AIM 1，我们将使用国家行政数据描述透析PCT工作人员的模式(例如，PCT的数量， 随着时间的推移，PCT职位空缺的百分比，PCT：患者和PCT：其他工作人员的比率)并探索 这种人员配置与患者结果的关系(例如，住院、死亡率、移植和等待名单， 永久性血管通路使用)使用定量方法。在目标2中，我们将探索对角色的认知 透析PCT的能力、PCT培训干预的轻重缓急以及潜在的障碍 采用定性方法实施。具体来说，我们将举办六个焦点小组(每个小组6-8个)， 跨学科透析护理团队成员(两名PCT；两名医生、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 (例如，沟通、文化能力、以人为中心的护理提供、组织文化)将需要 需要解决的问题是让PCT成为透析护理团队的宝贵成员。这一建议形成了 研究，使用二次数据分析和定性数据收集，将增加我们对 透析PCT人员配备及其与患者预后的潜在关联； 正在或可能由透析PCT提供的血液透析的技术管理；以及 透析PCT中是否有足够的培训和知识来提供这种护理。收集到的初步数据 这将直接通知未来的研究，将为提高整个透析的能力奠定基础 护理团队更好地使用透析PCT-最终实现全面、协调的全人360- 学位关怀，在不成比例的低收入人群中优化个人和人群的健康结果 以及接受中心HD治疗的少数族裔和老年美国患者。

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.