背景:随着各国对老年人入院率上升的反应,设计服务以支持离家更近的医疗保健服务的尝试采取了各种形式,有医院获得性发病风险的人,延长住院时间和再入院时间。支持这些服务发展的证据有限。我们正在进行过程评估,除了一项英国多站点随机试验,了解在家庭服务中实施老年病学家主导的入院回避医院的背景和实践,并探索干预可能有效的方法,在什么条件下,为谁,以及它与住院护理有何不同。
方法:我们正在采访患者及其护理人员,来自英国各地参与的国家卫生服务(NHS)信托基金的有目的地抽样的网站。我们还参观了一些地方,观察当地的流程,并与一系列多学科工作人员讨论服务的建立和运行,经理,专员,初级保健和社会服务代表。我们的目标是采访大约36名患者及其护理人员,这些患者及其护理人员在家中或住院服务的经验;三个站点各有12个。我们将使用内容分析方法来探索跨参与者的数据,服务和网站。
结论:该过程评估将在了解试验结果之前评估实施过程。我们涵盖了触及的领域,delivery,改变,背景和患者对干预的反应,他们的照顾者,卫生专业人员和卫生系统。
背景:ISRCTN60477865。2014年3月10日注册试验赞助商:牛津大学。3.1版本,于2016年6月14日注册。
BACKGROUND: Attempts to design services to support the delivery of healthcare closer to home have taken various forms as countries respond to an increase in hospital admission rates for older people, who are at risk of hospital-acquired morbidity, prolonged lengths of stay and readmission. Evidence to support the development of these services is limited. We are conducting a process evaluation, alongside a UK multi-site randomised
trial, to understand the contexts and practices of implementing geriatrician-led admission avoidance hospital at home services and to explore ways that the intervention might be effective, under what conditions, for whom, and how it differs from inpatient care.
METHODS: We are interviewing patients and their caregivers, from sites that are purposively sampled from participating National Health Service (NHS) trusts across the UK. We are also visiting sites to observe local processes and discuss the establishment and running of services with a range of multidisciplinary staff, managers, commissioners, primary care and social services representatives. We aim to interview approximately 36 patients and their caregivers with experience of hospital at home or inpatient services; 12 at each of three sites. We will use a content analysis approach to explore data across participants, services and sites.
CONCLUSIONS: This process evaluation will enable evaluation of implementation processes prior to knowing
trial outcomes. We encompass domains of reach, delivery, change, context and response to the intervention by patients, their carers, health professionals and the health system.
BACKGROUND: ISRCTN60477865 . Registered on 10 March 2014.
Trial sponsor: University of Oxford. Version 3.1, registered on 14 June 2016.