背景:满足关节置换需求预期增长的能力需要安全,有效的护理模式。虽然短期关节置换计划正在国际上使用,它们在许多国家没有得到广泛实施。重要的是,在大规模计划实施之前需要解决的关键挑战仍然不清楚。本研究旨在调查利益相关者对短期关节置换计划的看法,包括感知到的实施和可持续性障碍和促成因素,了解澳大利亚的现行做法。
方法:邀请了四个主要利益相关者团体参加这项全国性研究:(1)提供关节置换护理的卫生专业人员;(2)参与关节置换的医院管理人员;(3)最近进行关节置换的患者;(4)最近进行关节置换的患者的护理人员。关于感知可行性的数据(0(完全不可行)-10(高度可行),上诉(0(完全没有吸引力)-10(极具吸引力),目前的做法,使用视觉模拟量表收集障碍和促成因素,多个回答选项和开放式问题,通过在线平台。进行了描述性分析和自由文本内容分析。
结果:数据来自1,445名参与者,包括360名卫生专业人员,20名医院管理人员,1034名患者,和31个照顾者。卫生专业人员(中位数6,四分位距(IQR)3-8)和医院管理人员(中位数5,IQR5-6)认为短期计划的实施是可行的。短期治疗方案对患者的吸引力中等(中位数7,IQR2-9),但对护理人员的吸引力不大(中位数3,IQR1-7)。突出的实施障碍包括认为短期逗留计划的适当性有限,家庭支持不足,以及围绕报销模式或计划资金的问题。对于患者来说,没有日常的理疗机会以及在家中对疼痛和活动能力的担忧是常见的障碍。关注患者管理日常活动的能力是护理人员最常见的障碍。获得出院后服务,更好的融资模式,改进人员配备,一致的协议和国家护理标准是突出的推动因素。
结论:这项全国性研究独特地捕获了多个利益相关者对短期关节置换计划的观点。研究结果可以指导未来的质量改善和实施计划,以及开发资源以最佳地支持患者,看护者,临床医生,和医院。
BACKGROUND: The capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This
study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia.
METHODS: Four key stakeholder groups were invited to participate in this national
study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) - 10 (highly feasible), appeal (0 (not at all appealing) - 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken.
RESULTS: Data were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3-8) and hospital administrators (median 5, IQR 5-6). Short-stay programs were moderately appealing to patients (median 7, IQR 2-9) but of little appeal to carers (median 3, IQR 1-7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients\' ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers.
CONCLUSIONS: This national
study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.