Uncovering Caregiver Discharge Readiness for Patient Care Transitions from Hospital to Home: The UCare Study

项目摘要 在美国，每五个人中就有一个人，即5300万人，目前正在担任无薪照顾者。 护理人员通过导航医疗保健系统， 管理复杂的护理，并倡导患者的需求。在医院的高风险过程中 出院后，护理人员的参与支持了护理的准备和连续性; 护理人员出院导致再入院的风险增加。CMS需要教育 患者、家人、监护人和/或护理人员关于自我管理、独立生活和日常活动的信息 生活，以便报销“护理管理”服务，30多个国家已通过了 《护理者建议记录启用法案》（CARE）要求护理者积极参与出院计划 和教育然而，没有独特的结果衡量标准来评估准备充分的程度。 照顾者须在被照顾者出院后从事照顾活动。目前的措施 照顾者1）只关注一般照顾者的结果，如身心健康，2） 开发用于回顾性报告过渡期护理质量与真实的临床中的及时应用 设置，或3）缺乏严格的心理测试报告。简单地说，目前的措施没有捕捉到 照顾者对自身在医院高风险事件中的准备程度的具体认知 放电因此，卫生系统缺乏评估出院有效性的实际措施 照顾者的准备，我们没有一个坚定的理解照顾者准备如何可能 帮助病人安全回家。这项研究的目的是开发和测试一种措施， 捕捉到的独特因素重要的照顾者的感情准备从事的照顾。使用 混合方法的方法，本研究的具体目标是1）发展一个理论上的基础， 心理测量学上健全的照顾者出院准备量表（FamRHDS-R）; 2）建立 新的FamRHDS-R的心理测量特性和测量不变性;以及3）建立是否和 新的FamRHDS-R如何与一系列护理人员和患者结果相关联。整体 一个假设是，新的FamRHDS-R评估照顾者是否愿意参与照顾， 捕获并解释出院后患者和护理人员结果的变异性。因为这项研究是 对卫生系统和护理人员的需求作出反应，并寻求完善和测试一个基于以下方面的工具： 全国35个以上的卫生系统已经实施了这些措施，这项非常重要的研究是很好的。 能够显著影响出院质量和健康结果，包括减少 再入院和护理总成本。

PROJECT SUMMARY One in five individuals, or 53 million people, are currently acting as unpaid caregivers in the United States. Caregivers directly contribute to patient safety and health outcomes by navigating health care systems, managing complex care, and advocating for the needs of patients. During the high-risk process of hospital discharge, caregiver involvement supports preparedness and continuity of care; decreased preparedness of caregivers for discharge results in an increased risk for readmission to the hospital. CMS requires education of patients, family, guardians, and/or caregivers about self-management, independent living, and activities of daily living in order to be reimbursed for “care management” services, and more than 30 states have adopted the Caregiver Advise Record Enable (CARE) Act requiring active engagement of caregivers in discharge planning and education. However, there is no unique outcome measure available to assess how well-prepared caregivers are to engage in caregiving activities after care recipients’ hospital discharge. Current measures of caregivers 1) focus exclusively on general caregiver outcomes such as physical and mental wellbeing, 2) were developed for retrospective reporting of transitional care quality vs timely application in real world clinical settings, or 3) lack rigorous reporting of psychometric testing. Simply put, current measures don’t capture caregivers’ specific perceptions about their own level of preparedness during the high-risk event of hospital discharge. As a result, health systems lack a practical measure for assessing the effectiveness of discharge preparation of caregivers, and we are left without a firm understanding of how caregiver readiness may contribute to patients’ safe transitions home. The goal of this study is to develop and test a measure that captures the unique factors important to caregivers’ feelings of readiness to engage in caregiving. Using a mixed-methods approach, the specific aims of this study are to 1) develop a theoretically grounded and psychometrically sound caregiver hospital discharge readiness scale (FamRHDS-R); 2) establish the psychometric properties and measurement invariance of the new FamRHDS-R; and 3) establish whether and how the new FamRHDS-R is associated with a range of caregiver and patient outcomes. The overall hypothesis is that the new FamRHDS-R measure assessing caregiver readiness to engage in caregiving will capture and explain variability in post-discharge patient and caregiver outcomes. Because this study is responsive to the needs of both health systems and caregivers, and seeks to refine and test a tool based on measures already implemented in over 35 health systems nationwide, this highly significant study is well positioned to substantially impact hospital discharge quality and health outcomes including reduced readmissions and overall costs of care.