以质量改进为基础的方法,在心力衰竭过渡期护理患者中实施基于远程监测的捆绑方案
Joint Commission journal on quality and patient safety
|September 14, 2024
概括
远程患者监测 (RPM) 与心力衰竭 (HF) 捆绑相结合,包括社区护理医疗,显著减少了医院再入院. 进行了调整,以提高公平的入学率,解决不同患者群体的潜在技术障碍.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高科学 提高质量
- 健康 公平 卫生 公平
背景情况:
- 充血性心力衰竭 (HF) 是住院的主要原因,不成比例地影响少数群体和扩大死亡率差距.
- 远程患者监测 (RPM) 为出院后的护理提供了潜力,但可能会加剧由于技术障碍而导致的健康不平等.
研究的目的:
- 实施和评估心力衰竭 (HF) 管理的质量改进倡议,使用以公平的角度进行远程患者监测 (RPM).
- 评估综合性HF护理包对医院再接收率和入院公平性的影响.
主要方法:
- 一个前性的观测质量改善 (QI) 计划在一个地点使用了五个计划-做-研究-行动 (PDSA) 周期.
- 该干预涉及心力衰竭 (HF) 包,包括RPM,临床电药,远程治疗监测和社区护理.
- 计划中期进行了调整,以改善公平的入学率,从基于蜂的设备转向基于枢纽的设备.
主要成果:
- 完整的HF捆绑 (RPM + 其他服务) 导致重新接收率为2.6%,而部分捆绑则为14.3%,单独RPM则为20.0%.
- 社区护理医疗被确定为计划成功的关键组成部分.
- 在调整计划以适应多样化的技术访问后,公平的患者入学改善了.
结论:
- 一个基于HF的RPM程序与临床远程医疗和社区护理医疗集成,有效地减少了医院再入院.
- 该倡议成功地发现并解决了服务分配中的差异,改善了公平.
- 质量改进策略,包括计划中期调整,对于优化RPM有效性和HF护理中的公平性至关重要.
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