一个基于远程医疗的过渡期护理模型,用于医疗复杂性的儿童
Susan Fisk1, Fidelity Dominguez, Kari Price
1Susan Fisk is clinical transitions program director at MGA Homecare in Denver. Fidelity Dominguez is a process improvement specialist, Kari Price is an RN, Mark S. Brittan, Brooke Geyer, and Christina Olson are hospitalists, Eric Cibak is manager of case management, Jill Callahan is a case manager, and Irina Topoz is a physician, all at Children's Hospital Colorado in Aurora. Proof of concept was supported through Colorado's Medicaid Upper Payment Limit funds (Grant No. 550002). The authors acknowledge the use of ChatGPT to improve the clarity of the language. Contact author: Susan Fisk, fiskds@comcast.net. The authors have disclosed no potential conflicts of interest, financial or otherwise.
一个针对有医疗复杂性 (CMC) 的儿童的新型远程医疗计划显著降低了30天的再入院率,从17.6%降至10.1%. 这种由护士主导的干预措施有效地解决了护理障碍,并减少了急诊室的重新访问.
科学领域:
- 儿科医疗保健 儿科医疗保健
- 护理实践 护理实践
- 医疗保健服务研究 医疗服务研究
背景情况:
- 患有医疗复杂性 (CMC) 的儿童在出院后面临高再接收风险和护理障碍.
- 现有计划在减少CMC的再入院和护理碎片化方面表现出不同的成功.
研究的目的:
- 实施和评估一个使用全方位护理实践的远程医疗计划,以改善CMC的医院到家庭过渡.
- 实现对CMC的30天再接收率的10%降低.
主要方法:
- 一项远程医疗干预涉及虚拟护士访问,对符合条件的住院患者在出院后3-7天.
- 在30天内对门诊团队进行后续护理和移交,旨在减少护理碎片化.
- 主要结果:30天再接收率;次要结果:护理障碍识别/解决和30天ED再访率.
主要成果:
- 在四年 (2020年1月至2024年6月) 中,30天再接收率从17.6%降至10.1%.
- 护士在51%的遭遇中发现了护理障碍,特别是预约安排和医疗用品的采购.
- 30天ED重复检查率从12.4%下降到10.3%.
结论:
- 利用护士的全部实践范围有效地减少了高风险儿科人口的再入院.
- 该计划的新特征包括最低限度的排除标准,综合护理团队,以及为各种需求提供单一的联系点.
- 在另一家医院成功复制表明该模型的潜力更广泛实施,以减少复杂患者的再入院.
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