实施严重疾病风险预测模型:对护理目标的影响 文件
Jane O Schell1, Yael Schenker2, Gina Piscitello2
1Section of Palliative Care and Medical Ethics (J.O.S., Y.S., G.P., R.M.A.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Renal-Electrolyte Division (J.O.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Palliative Research Center (J.O.S., Y.S., G.P., S.C.B., E.J.C., R.M.A.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
实施护理目标倡议显著改善了高风险患者的文档. 这项质量改进工作加强了重病住院人员的护理规划.
科学领域:
- 提高质量 提高质量
- 医疗保健服务研究 医疗服务研究
- 抚慰性护理是一种缓解性护理.
背景情况:
- 护理目标对话对于严重疾病的高价值护理至关重要,但在医院中很少记录.
- 改善这些讨论的记录对于以患者为中心的护理规划至关重要.
研究的目的:
- 开发和实施质量改进计划,以提高住院患者护理文档的目标.
- 评估一种新型干预措施对护理目标的费率和提供者的影响.
主要方法:
- 在一个学术医疗中心实施了一项质量改善倡议.
- 该干预措施集成了一个90天死亡预测模型,一个集中的文档注释,以及有针对性的息咨询的自动通知.
- 记录的护理讨论目标在实施前和实施后进行了比较,按患者风险得分分层分.
主要成果:
- 实施后,高风险 (17.6%至70.8%) 和中等风险患者 (9.6%至28.0%) 的护理记录目标显著增加.
- 对于中等风险患者,息医学专家越来越多地进行了记录 (52.3%至71.2%).
- 对于高风险患者,初级服务完成了更多的文档 (36.8%至47.1%),而息专家的贡献略有下降 (63.2%至52.9%).
结论:
- 一个使用死亡率预测模型的护理目标倡议大大改善了文档,特别是在高风险患者中.
- 需要进一步的研究来优化策略,以提高中等风险患者的护理文档目标,特别是非息护理专家.
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