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国家行政结构如何影响全方位护理协调实施成果?

Jonathan R Olson1, Kimberly M Estep1, Kimberly A Coviello1

  • 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Olson, Bruns); Innovations Institute, University of Connecticut School of Social Work, Hartford (Estep, Coviello); Department of Psychology, Virginia Commonwealth University, Richmond (Linkous).

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概括

与社区心理健康中心 (CMHCs) 相比,护理管理实体 (CMEs) 在全面护理协调方面表现出更好的实施结果. 优化内部和外部环境对于有效实施复杂的行为健康策略至关重要.

关键词:
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科学领域:

  • 实施科学 实施科学
  • 医疗服务研究 医疗服务研究
  • 行为健康系统 行为健康系统

背景情况:

  • 包裹式护理协调是针对有复杂行为健康需求的年轻人的基于证据的策略.
  • 这些策略的有效实施受到组织 (内部) 和系统 (外部) 环境的影响.

研究的目的:

  • 检查内部环境和外部环境变量如何影响包裹式护理协调的实施结果.
  • 为了比较两个国家级行政结构的有效性:护理管理实体 (CMEs) 和社区心理健康中心 (CMHCs).

主要方法:

  • 分析了来自10个州1178家供应商的数据.
  • 使用实施阶段完成工具评估了实施的完整性和持续时间.
  • 实践忠诚度用有效团队的教练观察措施来衡量.
  • 多级模型比较了CME和CMHC状态.

主要成果:

  • 与CMHC州相比,CME州的从业者忠诚度得分显著更高 (0.37对0.24).
  • 中型经济体国家完成了更多的实施活动,并且更快地完成了这些活动.
  • 较长的预实施阶段与忠实度正相关,而较长的实施阶段与负相关.

结论:

  • 国家级的行政结构,例如CME与CMHC,对包裹式护理协调的实施结果产生重大影响.
  • 足够的时间进行规划和实施,以及支持的内部和外部环境,对于实现高质量的服务提供至关重要.
  • 设计适合的组织和系统环境对于实施效率,完整性和整体质量至关重要.