Hospitalized older adults' care transition: themes, symptoms, QoL, and utilizatio

住院老年人的护理转变：主题、症状、生活质量和利用

基本信息

批准号：
8454954
负责人：
Carol Reynolds Geary
金额：
$ 3.33万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-26 至 2015-09-25
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8454954
关键词：
Accident and Emergency department Address Advanced Malignant Neoplasm Affect Area Back Behavior Care given by nurses Caregivers Caring Case Study Chronic Disease Clinical Complex Data Data Collection Distress Elderly Environment Event Failure Fee-for-Service Plans Foundations Health Health Care Reform Health Personnel Healthcare Healthcare Systems Heart Diseases Hospitals Individual Inpatients Intervention Interview Left Life Measures Medical Records Medicare Methods Mission Movement Nature Nurses Nursing Homes Outcome Outcomes Research Patient Care Patient Discharge Patient-Focused Outcomes Patients Pattern Physician Executives Population Probability Process Provider Psychological adjustment Quality of life Registered nurse Rehabilitation therapy Research Research Design Research Personnel Resources Risk Science Scientist Skilled Nursing Facilities Source Staging Symptoms System Systems Development Time Training Universities Visit base care systems contextual factors cost design emotional adjustment experience health care service utilization high risk hospital readmission improved innovation older patient patient oriented pre-doctoral prospective public health relevance shift work statistics symptom management therapy development

项目摘要

DESCRIPTION (provided by applicant): This is a study of care transitions experienced by older adults with advanced chronic illness using complexity science as the conceptual framework. The purpose is to describe, from multiple perspectives, care transitions from hospital to a nursing home for skilled care and for the first 120 days following, including additional transitions that may occur. Aims of the study are to describe care transitions from the perspectives of patients, informal caregivers, and health care providers; to explore trajectories i patient quality of life and symptoms related to health care utilization (e.g., ER visits and hospitl readmissions); and to better understand patterns in the complexity of care transitions through cross-case comparison including both the qualitative themes and the quantitative measures. This prospective, mixed methods study will use multiple case studies with an embedded quantitative strand and multiple sources of information including interview, observation, and medical records review. Research that encompasses both patient and health care provider perspectives is highly significant in this era of health care reform and patient-centered outcomes research. Research completed to date is narrow in focus: addressing only patient symptoms and quality of life or system variables, such as readmission. In addition, research on the transition from hospital to skilled nursing care is limited both in quantity and scope. This result in a view of care transitions that does not adequately inform research or practice. An in-depth description of patients' care transition experiences from multiple perspectives across time is needed. The tenets of complexity science have informed study design and methods including the prospective nature of the study, data collection from multiple sources, and the incorporation of both qualitative and quantitative data. This study will provide a rich description of each patiet and his or her transition(s). Included are qualitative descriptions of the patients', caregivers' ad HCPs' perspectives, with quantitative patient-focused measures (QoL and symptoms) and systems-based measures (ER visits and hospital readmissions). This design allows the capture of the complexity of transition as well as the array of events, both clinical and context-based, that affect the decision to transfer. This unprecedented view will inform the development of interventions to improve care and decrease unnecessary utilization. As a key component of pre-doctoral training at a research-intensive university, this study will lay the foundation for a carer as an academic nurse scientist during an era of major reform in the U.S. health care system. It synthesizes a focus on NINR's mission to advance the science of symptom management and quality of life in patients with advanced, life-limiting conditions with the national imperative to make the U.S. health care system more patient-centered.

描述（由申请人提供）：这是一项以复杂性科学为概念框架，对患有晚期慢性病的老年人经历的护理转变进行的研究。目的是从多个角度描述从医院到疗养院进行熟练护理以及随后的前 120 天的护理过渡，包括可能发生的其他过渡。该研究的目的是从患者、非正式护理人员和医疗保健提供者的角度描述护理转变；探索患者生活质量的轨迹和与医疗保健利用相关的症状（例如急诊室就诊和再入院）；通过跨案例比较，包括定性主题和定量措施，更好地理解护理转变的复杂性模式。这项前瞻性、混合方法的研究将使用多个案例研究，并嵌入定量链和多种信息来源，包括访谈、观察和病历审查。在这个医疗保健改革和以患者为中心的结果研究的时代，涵盖患者和医疗保健提供者观点的研究非常重要。迄今为止完成的研究焦点狭窄：仅解决患者症状和生活质量或系统变量，例如再入院。此外，关于从医院到熟练护理的转变的研究在数量和范围上都有限。这导致护理转变的观点无法充分为研究或实践提供信息。需要从多个角度跨时间深入描述患者的护理过渡经历。复杂性科学的原则为研究设计和方法提供了信息，包括研究的前瞻性、来自多个来源的数据收集以及定性和定量数据的结合。这项研究将对每个患者及其转变进行丰富的描述。其中包括对患者、护理人员和 HCP 观点的定性描述，以及以患者为中心的定量措施（生活质量和症状）和基于系统的措施（急诊室就诊和再入院）。这种设计可以捕获过渡的复杂性以及影响过渡决策的一系列事件（包括临床事件和基于背景的事件）。这一前所未有的观点将为干预措施的制定提供信息，以改善护理并减少不必要的使用。作为研究密集型大学博士前培训的关键组成部分，这项研究将为美国医疗保健系统重大改革时代的护理人员成为学术护士科学家奠定基础。它综合了 NINR 使命的重点，即推动晚期、生命受限患者的症状管理科学和生活质量，以及国家的迫切需要使美国的医疗保健系统更加以患者为中心。