背景:卫生系统碎片化直接导致患有多种慢性疾病的老年人及其护理伙伴的健康和社会结果不佳。老年人通常需要初级保健的支持,多个专家,家庭护理,社区支持服务,和其他卫生保健部门,这些提供者之间的沟通是非结构化的,也不是标准化的。综合和跨专业的基于团队的护理模式是改善向有复杂需求的老年人提供卫生服务的推荐策略。在数字平台上部署的标准化评估工具被认为是综合护理的必要组成部分。这项研究的目的是制定策略来利用电子健康工具,interRAI检查自我报告,支持安大略省南部社区中老年人及其护理伙伴的综合健康和社会护理,加拿大。
方法:组概念图,参与式混合方法,进行了。参与者包括老年人,护理伙伴,和代表来自:家庭护理,社区支持服务,专门的老年服务,初级保健,和健康信息学。在一系列虚拟会议中,参与者提出了实施内部RAI检查的想法,并对这些想法的相对重要性进行了评级。层次聚类分析用于将想法映射到类似陈述的聚类中。与会者审查了地图,以共同制定行动计划。
结果:41名参与者贡献了十个动作区域的聚类图(例如,老年人和护理伙伴的参与,仪器的易用性,评估过程的可及性,以人为本的过程,对提供者的培训和教育,提供商协调,卫生信息集成,卫生系统决策支持和质量改进,隐私和保密)。卫生系统决策支持集群被评为相对重要性最低,健康信息集成被评为相对重要性最高。
结论:许多人-,提供者-,在健康和社会护理提供者实施和使用电子健康工具时,需要考虑系统级因素。这些因素与将其他标准化工具整合到跨专业团队护理中高度相关,以确保在引入技术时采用富有同情心的护理方法。
BACKGROUND: Health system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada.
METHODS: Group concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan.
RESULTS: Forty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument\'s ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance.
CONCLUSIONS: Many person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.