背景:家庭护理客户端服务通常分布在几个相互依赖的医疗保健提供者之间,使适当的护理协调至关重要。然而,由于在家庭护理环境中探索护理协调的研究很少,关于各种因素如何影响该护理部门的协调,存在严重的知识差距。为了填补这些空白,这项研究的中心目的是探索外部因素(即,财务和监管机制)和家庭护理机构特征(即,工作环境,劳动力,和客户特征)与家庭护理中的护理协调有关。
方法:该分析是国家多中心的一部分,在瑞士家庭护理设置的横断面研究,包括88个瑞士家庭护理机构的分层随机样本。数据是在2021年1月至9月之间通过机构和员工问卷收集的。使用我们新开发的护理协调框架,COORA,我们对变量进行了建模,以评估结构上护理协调的相关组成部分,process,和结果水平。我们进行了描述性和多层次回归分析,后者根据机构内部的依赖性进行了调整,以探索与协调相关的关键因素。
结果:最终样本量由71个家庭护理机构的1450名员工组成。我们发现一个明确的协调机制(“沟通和信息交换”(β=0.10,p<.001))和四个隐含的协调机制-“卫生系统知识”(β=-0.07,p<.01),“角色清晰度”(β=0.07,p<.001),“相互尊重和信任”(β=0.07,p<.001),和“问责制”,可预测性,共同视角“(β=0.19,p<.001)-与员工感知的协调显著正相关。我们还发现,代理特征和外部因素的影响是通过协调过程介导的。
结论:内隐协调机制,能够促进和加强团队沟通,需要更仔细的检查。在制定战略以加强隐性机制的同时,整个护理团队的参与对于创建结构(即,明确的机制),使通信和信息交换成为可能。适当的协调过程似乎减轻了人员配置和协调之间的联系。这表明即使在工作量和加班较高时,它们也支持协调。
BACKGROUND: Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence
coordination in this care sector. To fill such gaps, this
study\'s central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare.
METHODS: This analysis was part of a national multicentre, cross-sectional
study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care
coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses-with the latter adjusting for dependencies within agencies-to explore which key factors are associated with coordination.
RESULTS: The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism (\"communication and information exchange\" (beta = 0.10, p <.001)) and four implicit coordination mechanisms-\"knowledge of the health system\" (beta = -0.07, p <.01), \"role clarity\" (beta = 0.07, p <.001), \"mutual respect and trust\" (beta = 0.07, p <.001), and \"accountability, predictability, common perspective\" (beta = 0.19, p <.001)-were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes.
CONCLUSIONS: Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate
coordination processes seem to mitigate the association between staffing and
coordination. This suggests that they support coordination even when workload and overtime are higher.