Abstract：
BACKGROUND: Home parenteral nutrition (HPN) is a life-saving therapy required for the management of type III intestinal failure, one of the rarest organ failures. It requires a multidisciplinary approach to manage the complexity of the underlying medical, surgical, and nutrition issues, but the current levels of healthcare funding in Australia are unknown. This study aimed to quantify the caseload, staffing, and capacity of existing HPN centers nationally.
METHODS: This was a cross-sectional survey inviting centers known to provide HPN care. The survey was designed to capture metrics related to the national framework for the delivery of HPN. These centered on staffing levels, patient load, capacity to audit key outcomes, and service challenges.
RESULTS: A total of 24 (89%) of 27 invited centers responded to the survey. There were 17 (71%) adult centers and 7 (29%) pediatric centers. Adult centers managed a median of 12 (interquartile range [IQR]: 6-25) patients vs 16 (IQR: 9-17) in pediatric centers. Several centers did not have dedicated funding for core team members. The total funded clinician time each week per patient was 7 min (IQR: 0-12 min) in adult centers and 14 min (IQR: 10-21 min) in pediatric centers. Fewer than half of centers reported having sufficient resources to regularly audit key metrics.
CONCLUSIONS: The availability of dedicated expertise to manage the highly complex needs of people living with type III intestinal failure is lacking in Australia. Current funding of HPN services falls well short of being sufficient to meet the requirements outlined in the national quality framework.
METHODS: This was a cross-sectional survey inviting centers known to provide HPN care. The survey was designed to capture metrics related to the national framework for the delivery of HPN. These centered on staffing levels, patient load, capacity to audit key outcomes, and service challenges.
RESULTS: A total of 24 (89%) of 27 invited centers responded to the survey. There were 17 (71%) adult centers and 7 (29%) pediatric centers. Adult centers managed a median of 12 (interquartile range [IQR]: 6-25) patients vs 16 (IQR: 9-17) in pediatric centers. Several centers did not have dedicated funding for core team members. The total funded clinician time each week per patient was 7 min (IQR: 0-12 min) in adult centers and 14 min (IQR: 10-21 min) in pediatric centers. Fewer than half of centers reported having sufficient resources to regularly audit key metrics.
CONCLUSIONS: The availability of dedicated expertise to manage the highly complex needs of people living with type III intestinal failure is lacking in Australia. Current funding of HPN services falls well short of being sufficient to meet the requirements outlined in the national quality framework.
摘要：
背景：家庭肠外营养（HPN）是治疗III型肠衰竭所需的救命疗法，最罕见的器官衰竭之一。它需要多学科的方法来管理基础医疗的复杂性，外科,和营养问题，但目前的医疗资金在澳大利亚的水平是未知的。这项研究旨在量化案件量，人员配备，以及全国现有HPN中心的能力。
方法：这是一项横断面调查，邀请已知提供HPN护理的中心。该调查旨在获取与提供HPN的国家框架相关的指标。这些以人员配备水平为中心，病人负荷，审计关键成果的能力，和服务挑战。
结果：27个受邀中心中，共有24个（89%）回复了调查。有17个（71％）成人中心和7个（29％）儿科中心。成人中心管理的中位患者为12（四分位距[IQR]：6-25），而儿科中心的中位患者为16（IQR：9-17）。几个中心没有为核心团队成员提供专项资金。在成人中心，每位患者每周的临床医生总资助时间为7分钟（IQR：0-12分钟），在儿科中心为14分钟（IQR：10-21分钟）。不到一半的中心报告有足够的资源来定期审核关键指标。
结论：澳大利亚缺乏专门的专业知识来管理III型肠衰竭患者的高度复杂需求。HPN服务的当前资金远远不足以满足国家质量框架中概述的要求。
方法：这是一项横断面调查，邀请已知提供HPN护理的中心。该调查旨在获取与提供HPN的国家框架相关的指标。这些以人员配备水平为中心，病人负荷，审计关键成果的能力，和服务挑战。
结果：27个受邀中心中，共有24个（89%）回复了调查。有17个（71％）成人中心和7个（29％）儿科中心。成人中心管理的中位患者为12（四分位距[IQR]：6-25），而儿科中心的中位患者为16（IQR：9-17）。几个中心没有为核心团队成员提供专项资金。在成人中心，每位患者每周的临床医生总资助时间为7分钟（IQR：0-12分钟），在儿科中心为14分钟（IQR：10-21分钟）。不到一半的中心报告有足够的资源来定期审核关键指标。
结论：澳大利亚缺乏专门的专业知识来管理III型肠衰竭患者的高度复杂需求。HPN服务的当前资金远远不足以满足国家质量框架中概述的要求。
