实施4M的卫生系统方法和经验:来自3个早期采用者卫生系统的见解
Julia R Adler-Milstein1,2, Grace N Krueger2, Sarah W Rosenthal2
1Department of Medicine, University of California, San Francisco, California, USA.
Journal of the American Geriatrics Society
|May 29, 2023
概括
实施4M框架的老年友好护理需要一个统一的愿景和多学科的领导. 成功的策略包括明确的沟通和临床支持,克服诸如碎片化努力和医生脱离干预等障碍.
科学领域:
- 实施科学 实施科学
- 老年人医疗保健 医疗保健
- 卫生系统研究 卫生系统研究
背景情况:
- 医疗保健系统需要重新设计,以便为老年人提供有效的,定制的护理.
- 4M (重要的是什么,流动性,药物,心理) 框架指导年龄友好的护理服务.
- 本研究使用实施科学框架评估了4M的实际实施情况.
研究的目的:
- 用4M框架来描述和评估现实世界的实施经验.
- 识别各种卫生系统实施老年友好护理的促进者和障碍.
主要方法:
- 选择了三个早期采用者健康系统,具有不同的实施支持模型.
- 与各种利益相关者进行了29次半结构化访谈 (从领导到前线临床医生).
- 使用演编码 (实施研究综合框架) 和感应主题分析分析了采访数据.
主要成果:
- 卫生系统在4M实施顺序上有所不同;实施复杂且分散.
- 持续实施4M需要多学科,多层次的领导和参与.
- 促进者包括自上而下的沟通/基础设施和实践临床支持;障碍包括孤岛,不参与的医生和"重要的事情"的困难.
结论:
- 多因素领域影响4M实施,类似于其他实施研究.
- 实现老年友好型转型需要多个实施阶段的规划.
- 跨越学科和环境的统一愿景对于凝聚一致的年龄友好型转型至关重要.
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