PDF(Pubmed)
Abstract：
BACKGROUND: Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.
METHODS: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.
RESULTS: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.
CONCLUSIONS: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.
METHODS: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.
RESULTS: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.
CONCLUSIONS: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.
摘要：
背景：医疗保健系统的可持续性受到几个关键问题的挑战；最紧迫的问题之一是人口老龄化。传统,发作性护理提供模式不是为医疗复杂和虚弱的老年人设计的。这些人将受益于更全面的健康和社会护理，协调,以人为中心，在他们居住的社区中无障碍。做到这一点是一项具有挑战性的努力。以社区为基础的卫生和社会护理专业人员被孤立，分散在不同的地点和部门，每个人都有自己的心理模型，电子健康信息系统，和通信手段。为了摆脱零散的护理交付模式，转向更加综合的护理方法，我们在加拿大大西洋的一个城市地区对社区综合老年评估过程进行了分析.该研究的目的是确定在基于社区的全面老年评估过程中，向更综合的护理交付模式迈进的挑战和机遇。
方法：使用功能共振分析方法（FRAM）和动态FRAM（DynaFRAM）建模对基于社区的健康和社会护理系统进行建模，并创建假设的患者旅程场景。为建模而收集的数据包括文件审查，焦点小组,以及对在社区环境中为老年人提供护理和服务的健康和社会护理专业人员的半结构化访谈。
结果：确定了在当地背景下实施综合护理的挑战和机遇。FRAM和DynaFRAM分析的结果为多级流程改进建议的共同设计提供了依据，这些建议旨在将基于当地社区的综合老年评估流程推向更一体化的护理模式。
结论：在当地背景下对基于社区的健康和社会护理进行变革性的重新设计是必要的，但如果不了解健康和社会护理专业人员如何开展工作以及老年人如何在动态条件下接受护理，就无法实现。FRAM和DynaFRAM模型提供了对系统操作和功能的更好理解，并展示了决策者在实施更加集成的护理模型时不应该忽视的关键步骤。
方法：使用功能共振分析方法（FRAM）和动态FRAM（DynaFRAM）建模对基于社区的健康和社会护理系统进行建模，并创建假设的患者旅程场景。为建模而收集的数据包括文件审查，焦点小组,以及对在社区环境中为老年人提供护理和服务的健康和社会护理专业人员的半结构化访谈。
结果：确定了在当地背景下实施综合护理的挑战和机遇。FRAM和DynaFRAM分析的结果为多级流程改进建议的共同设计提供了依据，这些建议旨在将基于当地社区的综合老年评估流程推向更一体化的护理模式。
结论：在当地背景下对基于社区的健康和社会护理进行变革性的重新设计是必要的，但如果不了解健康和社会护理专业人员如何开展工作以及老年人如何在动态条件下接受护理，就无法实现。FRAM和DynaFRAM模型提供了对系统操作和功能的更好理解，并展示了决策者在实施更加集成的护理模型时不应该忽视的关键步骤。
