在医院环境中通过患者导航程序支持的老年人的特征和轨迹:一个队列观察性研究
Grace Liu1, Kristina M Kokorelias2,3, Amanda Knoepfli4
1St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 285 Cummer Ave, Toronto, ONM2M 2G1, Canada.
Canadian journal on aging = La revue canadienne du vieillissement
|November 14, 2024
概括
一个新的患者导航计划成功地支持老年人从医院过渡到家. 该计划促进了社区服务转诊和出院计划,改善了老年患者的护理过渡.
科学领域:
- 老年学是一门学科.
- 医疗保健管理的管理
- 社会工作 社会工作 社会工作
背景情况:
- 对于具有复杂护理需求的老年人来说,医院到家庭的过渡是具有挑战性的.
- 有效的患者导航计划对于改善护理连续性至关重要.
- 现有的模型需要评估,以优化对老年人群的支持.
研究的目的:
- 评估一项新型患者导航 (PN) 计划,旨在为从医院到家庭过渡的老年人设计.
- 描述患者的特征,患者导航员活动的范围和患者的结果.
- 为决策者提供有关在医院环境中实施PN计划的数据.
主要方法:
- 队列观察性研究设计.
- 对患者导航员临床笔记和医院行政数据的分析.
- 从2019年11月到2021年11月,包括90名55-95岁的患者 (平均年龄为78.9岁).
主要成果:
- 最常见的患者导航干预包括转诊到社区服务 (66%) 和出院计划 (61%).
- 该计划支持66%的患者返回家园,平均随访时间为74天.
- 作为嵌入式社会工作者,患者导航员在促进成功过渡方面发挥了关键作用.
结论:
- 患者导航计划有效地支持老年人在医院到家庭过渡期间.
- 转介到社区服务和出院规划是患者导航者的关键组成部分.
- 研究结果为实施和扩展老年护理患者导航计划提供了宝贵的见解.
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