PDF(Pubmed)
Abstract：
BACKGROUND: Increased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ).
METHODS: Informed by Donabedian\'s \'Evaluating the Quality of Medical Care\' model and the Institute of Medicine\'s Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre.
RESULTS: Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up.
CONCLUSIONS: Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.
METHODS: Informed by Donabedian\'s \'Evaluating the Quality of Medical Care\' model and the Institute of Medicine\'s Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre.
RESULTS: Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up.
CONCLUSIONS: Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.
摘要：
背景：增加的创伤存活率导致患者出院时对后续护理的更高需求。目前尚不清楚如何为患者提供重大创伤后的后续护理，以及如何，when,以及向谁提供后续服务。这项研究的目的是描述目前为在澳大利亚和新西兰（ANZ）遭受重大外伤的患者及其家人提供的后续护理。
方法：由Donabedian的“评估医疗质量”模型和医学研究所的医疗质量六个领域告知，我们与创伤专家联合开展了一项横断面在线调查.他们的答复为最终调查提供了信息，该调查分发给澳大利亚和新西兰71家医院的关键人员：（i）为患者提供创伤护理，(ii)向澳大拉西亚创伤登记处提供数据，或（iii）是创伤中心。
结果：数据来自38/71（53.5%）医院。大多数是1级创伤中心（n=23，60.5％）；76％（n=16）的后续服务得到了永久资助。后续服务由一系列卫生专业人员领导，超过60％（n=19）被确定为创伤专家。患者纳入标准各不相同；只有一项服务允许自我转诊(3.3%)。53％（n=16）的服务在急性护理出院后两周内进行了随访。护理活动侧重于身体健康；心理社会评估是最不常见的。大多数服务为成人和儿科创伤提供护理(60.5%，n=23）；没有为家庭成员提供后续服务。对后续护理的评估在很大程度上是卫生服务计划的一部分；只有三个地点表示评估是针对创伤随访的。
结论：后续护理由创伤专家提供，主要关注受严重创伤影响的患者的身体健康。在患者选择方面存在差异，在确定提供社会心理和家庭保健服务方面存在差距的情况下，开展后续和护理活动的原因。目前,对创伤后续护理的评估是有限的，表明需要进一步发展，以确保提供的护理是安全的，对患者有效和有益，家庭和医疗机构。
方法：由Donabedian的“评估医疗质量”模型和医学研究所的医疗质量六个领域告知，我们与创伤专家联合开展了一项横断面在线调查.他们的答复为最终调查提供了信息，该调查分发给澳大利亚和新西兰71家医院的关键人员：（i）为患者提供创伤护理，(ii)向澳大拉西亚创伤登记处提供数据，或（iii）是创伤中心。
结果：数据来自38/71（53.5%）医院。大多数是1级创伤中心（n=23，60.5％）；76％（n=16）的后续服务得到了永久资助。后续服务由一系列卫生专业人员领导，超过60％（n=19）被确定为创伤专家。患者纳入标准各不相同；只有一项服务允许自我转诊(3.3%)。53％（n=16）的服务在急性护理出院后两周内进行了随访。护理活动侧重于身体健康；心理社会评估是最不常见的。大多数服务为成人和儿科创伤提供护理(60.5%，n=23）；没有为家庭成员提供后续服务。对后续护理的评估在很大程度上是卫生服务计划的一部分；只有三个地点表示评估是针对创伤随访的。
结论：后续护理由创伤专家提供，主要关注受严重创伤影响的患者的身体健康。在患者选择方面存在差异，在确定提供社会心理和家庭保健服务方面存在差距的情况下，开展后续和护理活动的原因。目前,对创伤后续护理的评估是有限的，表明需要进一步发展，以确保提供的护理是安全的，对患者有效和有益，家庭和医疗机构。
