MATCHING NEEDS OF STROKE PATIENTS WITH CAREGIVING RESOURCES TO IMPROVE OUTCOMES

描述（由申请人提供）：中风是一种不可预测的、扰乱生活的事件，患者和家属几乎没有时间为其后果做好准备。中风患者从住院康复设施（irf）出院后，家庭成员往往被期望承担照顾任务，但却毫无准备，导致患者安全问题、照顾者负担、抑郁和生活质量下降。成功的出院后结果与可用护理资源和患者护理需求之间的匹配有关。本研究项目的长期目标是制定一级预防策略，以促进从IRF出院前的匹配。关键的初步步骤是探索患者和家属如何看待他们的护理资源需求，并将这些与协助他们制定出院计划的护士病例管理人员的观点进行比较。本研究采用基于理论的方法，将解决以下具体目标：1)建立一个概念性框架，说明资源和需求之间的匹配对脑卒中患者出院目的地的影响，因为它与从IRF出院的脑卒中患者有关；2)设计并试点一个基于研究的决策矩阵（算法），用于评估和匹配两个脑卒中中心的护理资源，以满足脑卒中患者及其家属的需求。将从两个irf中招募20个患者/家庭单位，其中包括中风患者、其主要非正式照护者和其他主要家庭成员。这些病人/家庭单位的成员将在病人住院期间和出院后6个月内接受面谈。开放式、结构松散的访谈问题将鼓励研究参与者描述关于出院目的地的决定是如何做出的，以及如何确定护理资源。基于这些访谈的发现，我们将开发一种决策算法。每个参与站点的两名护士病例管理人员将分别对三名患者进行算法试验。在试行算法后，将对这些护士病例管理人员进行访谈，以确定算法在实践中的适用性和有用性。本研究的结果将a)阐明与如何做出出院决定相关的维度，以及患者需求与护理资源之间的不匹配是如何发生的，b)指导决策矩阵（算法）的开发，供护士病例管理人员在帮助患者及其家属完成出院决策过程时使用。本提案针对R-15应用的以下NINR重点领域：护理质量和慢性疾病经历，以及它们对患者、家庭和护理人员生活质量的影响。

DESCRIPTION (provided by applicant): Stroke is an unpredictable, life-disrupting event allowing patients and families little time to prepare for its consequences. Family members are often expected, but unprepared, to take on caregiving tasks for stroke patients after discharge from inpatient rehabilitation facilities (IRFs) resulting in patient safety issues, caregiver burden, depression, and reduced quality of life. Successful post-discharge outcomes are related to the match between available caregiving resources and the patient's need for care. The long-term goal of this research program is to develop primary prevention strategies to facilitate this match prior to discharge from an IRF. A critical preliminary step requires exploring how patients and families perceive their caregiving resource needs, and to compare these with the perspectives of nurse case managers who assist them with discharge planning. Using grounded theory, the proposed study will address the following specific aims: 1) to develop a conceptual framework illustrating the influence of the match between resources and need as it relates to discharge destination for stroke patients being discharged from an IRF; and 2) to design and pilot a research-based, decision-making matrix (algorithm) for assessing and matching caregiving resources to the needs of stroke patients and their families at two IRFs. Twenty patient/family units, which will include the stroke patient, their primary informal caregivers, and other key family members, will be recruited from two IRFs. Members of these patient/family units will be interviewed during the patient's stay on the IRF and within 6 months post-discharge. Open-ended, loosely structured interview questions will encourage study participants to describe how decisions about discharge destination were made, and how caregiving resources were identified. A decision- making algorithm will be developed based on the findings from these interviews. Two nurse case managers at each of the participating sites will pilot the algorithm with three patients each. After piloting the algorithm, these nurse case managers will be interviewed to determine the applicability and usefulness of the algorithm in practice. Findings from this study will a) clarify the dimensions related to how discharge decisions are made and how mismatches between patient needs and caregiving resources occur, and b) guide the development of a decision-making matrix (algorithm) for nurse case managers to use when assisting patients and their families through the discharge decision-making process. This proposal addresses the following NINR areas of emphasis for R-15 applications: quality of care and chronic illness experiences, and their influence on quality of life for patients, families, and caregivers.