退伍军人从低急性康复到家庭的协调过渡性护理 (C-TraC)
Stephanie Denise M Sison1, Joyanne John2, Chi Mac3
1Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Journal of the American Medical Directors Association
|June 11, 2023
概括
这项研究适应了协调过渡护理 (C-TraC) 计划,用于从VA急性护理过渡的退伍军人. 调整后的模型增加了退役军人的退役后随访和密集的病例管理.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 过渡期护理模式的模型
- 退伍军人的医疗保健服务.
背景情况:
- 急性护理过渡模式可以适应急性护理后的环境.
- 退伍军人需要定制的过渡期护理策略.
- 弗吉尼亚州波士顿医疗保健系统试图改善护理过渡.
研究的目的:
- 为退伍军人从低急性护理转移到家庭的协调过渡期护理 (C-TraC) 计划进行调整.
- 评估适应模型的可行性和初步影响.
主要方法:
- 使用复制有效程序框架和计划-做-研究-行动周期.
- 调整了注册护士驱动的,基于电话的C-TraC干预.
- 放学协调员和过渡期护理病例经理的联合角色.
主要成果:
- 成功地将C-TraC适用于VA的亚急性护理环境.
- 核心干预组件 (95.9%-97.9%) 的高保真度.
- 与历史控制相比,在7天内增加了放免后的电话 (82.9%与61.9%,P = .03).
结论:
- 适应的C-TraC模型对于VA亚急性护理过渡是可行的.
- 这项干预措施加强了放免后的后续行动和病例管理.
- 需要在更大的队列中进行进一步评估,以评估重新入院等临床结果.
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