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.
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。