Systematic Assessment to Improve Hospice Outcomes

描述（由申请人提供）：完整、准确和系统的评估是在任何情况下提供有效护理的必要条件。然而，研究表明，这种评估经常在患者记录中缺失，导致护理不太理想。这种仔细评估的需要在临终关怀家庭护理中同样必要。每年有越来越多的病人接受临终关怀；因此，在这种情况下改善评估有可能改善每天对数千名患者的护理。本研究的主要目的，是要确定提供标准化评估工具系统反馈给安宁疗护病患与照护者，相较于通常做法，对改善安宁疗护结果的效果，此外，使用这些标准化评估，来辨识安宁疗护病患的症状群，以及它们如何影响病患与照护者的福祉。要测量的患者结果包括症状强度和痛苦、生活质量、抑郁和精神健康。被测量的护理结果包括抑郁、积极护理期间的精神健康、死亡后3个月和12个月的抑郁。306名患者/护理人员将从南佛罗里达大学临终关怀、姑息治疗和临终研究中心的三家大型临终关怀医院中抽取样本。患者必须患有癌症，并将使用简短的便携式精神状态问卷和姑息治疗表现量表进行筛选。在每个安宁疗护所，将会确定两个跨学科的疗护团队，为相同的病人群体提供家庭疗护；其中一个将被随机分为控制组和实验组。所有团队的病人和照护者将在安宁疗护入院后24-72小时内参与研究，并完成所有评估。对于实验小组，负责收集数据的注册护士和社会工作者将参加每周的跨学科小组会议，并报告他们在前一周收集的数据。数据收集和报告将在基线时进行，然后每周进行一次，持续两周，此时患者将完成研究。为了监测强化评估带来的护理变化，将对图表进行审计，以比较实验组和对照组之间家访、药物治疗和其他护理计划变化的次数。护理人员将在死亡后3个月和12个月再次访问，以评估对实验组患者提供的改善护理是否显著减少了抑郁症状。患者/护理人员将累积30个月，另外12个月的随访数据收集抑郁症数据。定量数据将使用混合模型分析、重复测量、多变量方差分析、判别函数分析和聚类分析进行分析。

DESCRIPTION (provided by applicant): Complete, accurate, and systematic assessment is known to be essential for providing effective care in any setting. However, research reveals that this assessment is frequently missing from patient records, leading to care that are less than ideal. This need for careful assessment is no less necessary in hospice homecare. Growing numbers of patients are receiving hospice care each year; thus, improving assessment in this setting has the potential for improving care to thousands of patients each day. The primary aims of this study are to determine the efficacy of providing systematic feedback from standardized assessment tools for hospice patients and caregivers in improving hospice outcomes compared to usual practice, and in addition, using those standardized assessments, to identify symptom clusters in hospice patients and how they impact on patient and caregiver well-being. Patient outcomes to be measured include symptom intensity and distress, quality of life, depression, and spiritual well-being. Caregiver outcomes being measured include depression, spiritual well-being during active care, and depression 3 and 12 months after the death. The sample of 306 patient/caregiver dyads will be drawn from three large hospices that are partners in the Center for Hospice, Palliative Care and End of Life Studies at the University of South Florida. Patients must have cancer, and will be screened using the Short Portable Mental Status Questionnaire and the Palliative Performance Scale. In each hospice, two interdisciplinary care teams will be identified that provide homecare to equivalent groups of patients; one will be randomized as the control team and one the experimental team. Patients and caregivers on all teams will be admitted to the study 24-72 hours after admission to hospice and will complete all assessments. For the experimental teams, the RN's and social workers who are collecting the data will attend the weekly interdisciplinary team meetings and report the data they have collected during the previous week. Data collection and reporting will occur at baseline and then weekly for two weeks at which time the patients will be finished with the study. In order to monitor care changes that result from the enhanced assessments, charts will be audited to compare the numbers of home visits and medication and other careplan changes between the experimental and control groups. Caregivers will be visited again at 3 and 12 months after the death to evaluate whether the improved care provided to patients on the experimental teams resulted in significantly less depressive symptoms. Patient/caregiver dyads will be accrued for 30 months with an additional 12 months of follow-up data collection for depression data. Quantitative data will be analyzed using mixed models analysis, repeated measures multivariate analysis of variance, discriminant function analysis and cluster analysis.