Role of the Patient Care Technician in Dialysis

患者护理技术人员在透析中的作用

• 批准号: 10704148
• 负责人: Laura Plantinga
• 金额: $ 5万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704148
• 关键词: Role; Patient; Care; Technician; Dialysis; Role; Patient; Care; Technician; Dialysis

PROJECT SUMMARY In the United States, >47,000 dialysis patient care technicians (PCTs) are responsible for the technical management of in-center hemodialysis (HD) for nearly 500,000 patients. The authority for dialysis PCTs to perform other clinical tasks varies by state, but it may be common practice to delegate inappropriate tasks to dialysis PCTs. In fact, there were <5000 licensed practical/vocational nurses nationwide in dialysis clinics in 2018, suggesting that dialysis PCTs are likely providing much of the medical care that might otherwise be assigned to these nurses. Further, relative to other team members, PCTs spend the most time with patients in the dialysis clinic, presenting a clear opportunity to engage dialysis PCTs in improving the quality of dialysis care overall. Even with mandated interdisciplinary dialysis care teams and ongoing national quality improvement efforts that are tied to reimbursement, delivery of high-quality, patient-centered dialysis care remains elusive in the United States. Our overarching goal is to explore the role of the dialysis PCT in dialysis care, informing future efforts to increase overall quality of care in the dialysis setting by engaging PCTs. In Aim 1, we will use national administrative data describe patterns of dialysis PCT staffing (e.g., number of PCTs, percentage of PCT positions that are open, PCT:patient and PCT:other staff ratios) over time and explore associations of this staffing with patient outcomes (e.g., hospitalization, mortality, transplant and waitlisting, permanent vascular access use) using quantitative methods. In Aim 2, we will explore perceptions of the roles and abilities of the dialysis PCT, priorities for PCT training interventions, and potential barriers to their implementation using qualitative methods. Specifically, we will conduct six focus groups (n=6-8 each) with interdisciplinary dialysis care team members (two with PCTs; two with physicians, nurses, social workers, dietitians, and administrators; two with in-center HD patients) to prioritize training needs and identify issues (e.g., communication, cultural competency, person-centered care delivery, organizational culture) that will need to be addressed for PCTs to become valued comembers of the dialysis care team. This proposed formative study, using both secondary data analysis and qualitative data collection, will increase our understanding of dialysis PCT staffing and its potential association with patient outcomes; the amount of care beyond the technical management of hemodialysis that is being, or could be, provided by dialysis PCTs; and the perceived adequacy of training and knowledge among dialysis PCTs to provide that care. The preliminary data collected here will directly inform future studies that will lay the groundwork to improve the ability of the entire dialysis care team to better engage dialysis PCTs—ultimately leading to integrated, coordinated whole-person, 360- degree care to optimize individual and population health outcomes among the disproportionately low-income and minority and older U.S. patients who receive in-center HD.

项目摘要 在美国，> 47,000个透析患者护理技术（PCT）负责技术 近500,000名患者的中心血液透析（HD）管理。透析PCT的权力 执行其他临床任务因州而异，但是将不适当的任务委托给 透析PCT。实际上，在全国范围内有<5000名持牌的实用/职业护士在透析诊所 2018年，表明透析PCT可能会提供许多否则可能是的医疗服务 分配给这些护士。此外，相对于其他团队成员，PCT在患者身上花费最多的时间 在透析诊所中，有一个明确的机会来吸引透析PCT以提高质量 总体而言，透析护理。即使有规定的跨学科透析护理团队和持续的国家质量 与报销，高质量，以患者为中心的透析护理相关的改进工作 在美国仍然难以捉摸。我们的总体目标是探索透析PCT在透析中的作用 护理，告知未来通过参与PCT来提高透析环境中总体护理质量的努力。目标 1，我们将使用国家行政数据描述透析PCT人员配备模式（例如，PCT数量， 随着时间的流逝 该人员配备与患者结果的关联（例如，住院，死亡率，移植和候补名单， 使用定量方法的永久性血管访问使用）。在AIM 2中，我们将探讨对角色的看法 透析PCT的能力，PCT培训干预措施的优先级以及潜在的障碍 使用定性方法实施。具体来说，我们将与 跨学科的透析护理团队成员（两个带有PCT；两名与医生，护士，社会工作者， 营养师和管理人员；两个患有中心高清患者）优先考虑培训需求并确定问题 （例如，沟通，文化能力，以人为本的护理交付，组织文化） 被授予PCT成为透析护理团队的有价值喜剧。此提议的格式 研究，使用二级数据分析和定性数据收集，将增加我们对 透析PCT人员配备及其与患者预后的潜在关联；超越的护理 透析PCT的血液透析技术管理；和感知到的 透析PCT中培训和知识的充分性，以提供这种护理。收集的初步数据 这里将直接告知将来的研究，该研究将奠定基础以提高整个透析的能力 护理团队更好地吸引透析PCT，从而导致整合，协调的全人组，360- 学位护理以优化不成比例的低收入的个人和人口健康结果 以及接受中心高清的少数民族和年长的美国患者。