多方面的实施策略的有效性,以增加公平的医院在家庭利用:一个中断的时间序列分析分析
Marc Kowalkowski1,2, Casey Stephens3, Timothy Hetherington4
1Department of Internal Medicine, Section of Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. mkowalko@wakehealth.edu.
Journal of general internal medicine
|July 9, 2024
概括
一个多方面的实施策略显著提高了家庭医院 (HaH) 的容量和提供者的采用. 这种方法还改善了包括农村居民在内的不同患者群体的HAH利用率.
科学领域:
- 医疗保健管理的管理
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
背景情况:
- 医院在家 (HaH) 计划在COVID-19大流行期间和CMS在家急性医院护理 (AHCaH) 豁免后迅速增长.
- 有限的证据表明,对于公平地扩大HAH利用的有效策略.
研究的目的:
- 评估多方面的实施策略对医院在家 (HaH) 使用的随时间推移的影响.
- 评估哈尔能力的变化,提供者推和患者人口统计数据.
主要方法:
- 使用电子健康记录 (EHR) 数据和中断时间序列分析进行前后评估.
- 与12名HaH患者和10名转诊临床医生进行定性访谈,以确定障碍物和促进者.
- 对比一个离散的实施策略 (教育外展) 与一个多方面的策略 (外展,护士导航员,行政参与,审计/反).
主要成果:
- 这种多方面的策略导致了 HaH 产能利用率 (OR 1.02) 和推提供商 (平均比率1.05) 的每周显著增加.
- 农村居民的HaH使用率增长最大,从11%上升到34%.
- 关键障碍包括信息缺口和转诊挑战,而以患者为中心是主要的促进因素.
结论:
- 一个多方面的实施策略有效地提高了高水平医疗能力,提供者采用和患者多样性.
- 卫生系统可以利用类似的上下文相关的多元组件策略,以公平地扩展HAH计划.
- 患者为中心的态度成为HaH采用的关键促进因素.
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