Engaging high-risk patients in intensive care coordination programs: the engagement through CARInG framework
Engaging high-risk patients in intensive care coordination programs: the engagement through CARInG framework
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DOI：
10.1093/tbm/ibx004
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发表时间：
2018-06-01
影响因子：
3.6
通讯作者：
Zulman, Donna M.
中科院分区：
文献类型：
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作者：
O'Brien, Colin W.;Breland, Jessica Y.;Zulman, Donna M.
重症监护计划(IOCP)对占急性护理利用率和费用不成比例的高危患者来说是有希望的。这些计划通常通过密集的病例管理、医疗保健导航、协调以及获得一系列社会和社区服务来满足医疗、行为和社会需求。然而，这些计划的价值往往受到患者参与挑战的限制(即难以让患者参与自我护理、决策和使用推荐服务的后续行动)。这项研究的目的是开发一个框架，让具有复杂医疗、行为和社会需求的高危患者参与IOCP。我们对来自不同环境(学术医院、县医疗系统、退伍军人事务机构、社区卫生中心和私人卫生系统)的12个IOCP的20名领导和临床医生(例如医生、护士、心理学家、病例工作者)进行了定性研究。在完成一项简短的调查后，参与者被要求描述他们的计划是如何概念化患者参与的，并描述高敬业度患者的特征。我们采用常规的内容分析方法对定性数据进行分析。通过关怀框架确定并总结了参与的三个领域：改善健康的沟通和行动；建立在对IOCP工作人员信任的基础上的关系；洞察力和制定目标的能力。定性的发现说明了这些领域的光谱和相互关联。通过关怀框架的参与可以指导旨在加强自我护理并改善对具有复杂医疗、行为和社会需求的高危患者的护理协调的干预措施。
Intensive outpatient care programs (IOCPs) have shown promise for high-risk patients who account for disproportionate acute care utilization and costs. These programs typically address medical, behavioral, and social needs through intensive case management, health care navigation, coordination, and access to a range of social and community services. However, the value of these programs is often limited by patient engagement challenges (i.e., difficulty engaging patients in self-care, decision- making, and follow-up with recommended services). The purpose of this study was to develop a framework for engaging high-risk patients with complex medical, behavioral, and social needs in IOCPs. We conducted a qualitative study with 20 leaders and clinicians (e.g., physicians, nurses, psychologists, case workers) from 12 IOCPs affiliated with diverse settings (academic hospitals, county healthcare systems, Veterans Affairs facilities, community health centers, and private health systems). After completing a brief survey, participants were asked to describe how their program conceptualizes patient engagement and to describe characteristics of highly engaged patients. We used conventional content analysis methods to analyze qualitative data. Three domains of engagement were identified and are summarized in the Engagement Through CARInG Framework: Communication and actions to improve health; Relationships built on trust in IOCP staff; and Insight and goal-setting ability. Qualitative findings illustrate the spectrum and interrelatedness of these domains. The Engagement Through CARInG Framework can guide interventions that aim to enhance self-care and improve care coordination for high-risk patients with complex medical, behavioral, and social needs.