Improving Heart Failure Disease Management in Skilled Nursing Facilities: Lessons Learned
Improving Heart Failure Disease Management in Skilled Nursing Facilities: Lessons Learned
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DOI：
10.1177/1054773813485088
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发表时间：
2013-11-01
影响因子：
1.7
通讯作者：
Boxer, Rebecca S.
中科院分区：
文献类型：
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作者：
Dolansky, Mary A.;Hitch, Jeanne A.;Boxer, Rebecca S.
本研究的目的是设计和评估在四个熟练护理机构(SNF)实施HF管理的改进项目。Kotter的变更管理原则被用来指导实施。此外，一半的设施有一名执行教练，他在4个月内每周与设施工作人员会面，在5个月内每月与设施工作人员会面。每周和每月进行审计，记录遵守议定书的八个关键方面。背景因素是通过实地笔记获取的。对HF管理方案的遵守程度从17%到82%不等。实施的促进者包括支持该项目的工作人员、实施教练和医生的参与。障碍是员工流动率高和等级文化。存在整合HF管理方案以改善SNF护理的机会。
The purpose of the study was to design and evaluate an improvement project that implemented HF management in four skilled nursing facilities (SNFs). Kotter's Change Management principles were used to guide the implementation. In addition, half of the facilities had an implementation coach who met with facility staff weekly for 4 months and monthly for 5 months. Weekly and monthly audits were performed that documented compliance with eight key aspects of the protocol. Contextual factors were captured using field notes. Adherence to the HF management protocols was variable ranging from 17% to 82%. Facilitators of implementation included staff who championed the project, an implementation coach, and physician involvement. Barriers were high staff turnover and a hierarchal culture. Opportunities exist to integrate HF management protocols to improve SNF care.