我国二级、三级医院延续性护理开展及评价情况调查
|
摘要
[目的]了解我国二级、三级医院延续性护理的开展情况及效果评价现况,为完善延续性护理的开展及评价提供建议。[方法]选取我国9个省、市57所医院的57名护理管理人员,对其所在医院延续性护理的服务对象、开展项目及效果评价进行调查。[结果]57所医院中,延续性护理的服务对象主要为高血压、糖尿病、脑卒中等慢性病病人,延续性护理开展的总体情况一般。延续性护理在电话随访、健康教育、用药管理方面开展得较好,在家庭访视、社区与医院协调转诊、组建多学科团队方面开展得较差。49所(86.0%)医院开展的延续性护理项目已建立联动模式,24所(42.1%)医院开展了医院-社区-家庭联动,但是在医院-社区联动方面的开展内容不足。延续性护理的效果评价主要聚焦于对病人健康照护结局的评价,而对延续性护理开展项目的评价不足。三级医院在制定出院计划和健康信息交换项目的开展率及导管相关性感染率指标的评价率高于二级医院(P<0.05)。[结论]我国二级、三级医院已广泛开展延续性护理服务,但在服务对象、开展内容及效果评价方面存在不足。建议医院进一步拓宽延续性护理服务对象,完善延续性护理的开展内容,加强对延续性护理的效果评价及医院-社区的联动与管理。
Objective:To understand the development status and effect evaluation of continuous nursing in secondary and tertiary hospitals in China,and to provide suggestions for improving the development and evaluation of continuous nursing.Methods:The 57 nursing management personnels of 9 provinces and cities and 57 hospitals in China were selected to take investigations on the service targets,project development and effect evaluation of the continuing care in their hospitals.Results:Among the 57 hospitals,the service subjects of continuous care were mainly for patients with chronic diseases such as hypertension,diabetes and stroke.The overall situation of continuous care was general.Continuing care carried out well in telephone follow-up,health education,and medication management,poorly conducted in family visits,community-to-hospital referrals,and multidisciplinary teams.49(86.0%) hospitals have established a linkage model for continuous care projects,and 24(42.1%) hospitals have carried out hospital-community-family linkages,but the implementation of hospital-community linkages has been insufficient.The evaluation of the effect of continuous care mainly has focused on the evaluation of the patient′s health care outcome,while the evaluation of the continuous care development project has been insufficient.The launching rate of making discharge plan and health information exchanging program,and evaluation rate of the catheter-related infection rate in the tertiary hospitals were higher than those of the secondary hospitals(P<0.05).Conclusion:Continuing care services have been widely carried out in secondary and tertiary hospitals in China,but there have been deficiencies in the service targets,content and effect evaluation.It is recommended that the hospital should further expand the scope of continuing care services,improve the content of continuous care,strengthen the effect evaluation of continuous care,and strengthen the linkage and management of hospitals-communities.
Objective:To understand the development status and effect evaluation of continuous nursing in secondary and tertiary hospitals in China,and to provide suggestions for improving the development and evaluation of continuous nursing.Methods:The 57 nursing management personnels of 9 provinces and cities and 57 hospitals in China were selected to take investigations on the service targets,project development and effect evaluation of the continuing care in their hospitals.Results:Among the 57 hospitals,the service subjects of continuous care were mainly for patients with chronic diseases such as hypertension,diabetes and stroke.The overall situation of continuous care was general.Continuing care carried out well in telephone follow-up,health education,and medication management,poorly conducted in family visits,community-to-hospital referrals,and multidisciplinary teams.49(86.0%) hospitals have established a linkage model for continuous care projects,and 24(42.1%) hospitals have carried out hospital-community-family linkages,but the implementation of hospital-community linkages has been insufficient.The evaluation of the effect of continuous care mainly has focused on the evaluation of the patient′s health care outcome,while the evaluation of the continuous care development project has been insufficient.The launching rate of making discharge plan and health information exchanging program,and evaluation rate of the catheter-related infection rate in the tertiary hospitals were higher than those of the secondary hospitals(P<0.05).Conclusion:Continuing care services have been widely carried out in secondary and tertiary hospitals in China,but there have been deficiencies in the service targets,content and effect evaluation.It is recommended that the hospital should further expand the scope of continuing care services,improve the content of continuous care,strengthen the effect evaluation of continuous care,and strengthen the linkage and management of hospitals-communities.
引文
[1] COLEMAN E A,BOULT C.Improving the quality of transitional care for persons with complex care needs[J].J Am Geriatr Soc,2003,51(4):556-557.
[2] 王娟,黄卡,林田,等.基于家庭医生责任制的脑卒中病人延续性照护模式的探讨[J].护理研究,2016,30(31):3939-3941.
[3] CAO X Y,TIAN L,CHEN L,et al.Effects of a hospital community partnership transitional program in patients with coronary heart disease in Chengdu,China:a randomized controlled trial[J].Jpn J Nurs Sci,2017,14(4):320-331.
[4] 陈燕.北京地区慢性心力衰竭患者延续性照护模式的初步探索[D].北京:北京协和医学院,2013.
[5] LEPPIN A L,GIONFRIDDO M R,KESSLER M,et al.Preventing 30-day hospital readmissions:a systematic review and meta-analysis of randomized trials[J].JAMA Intern Med,2014,174(7):1095-1107.
[6] JEFFS L,LAW M P,STRAUS S,et al.Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process[J].BMJ Qual Saf,2013,22(12):1014-1024.
[7] 陈璐,奚兴,JANET S.三级医院延续性护理服务质量评价指标体系的构建[J].护理学杂志,2015,30(10):94-97.
[8] 卫生部.中国护理事业发展规划纲要(2011—2015年).[EB/OL].(2011-12-31)[2018-10-05].http://www.moh.gov.cn/mohyzs/s3593/201201/53897.shtml.
[9] 施雁,孙晓,朱晓萍,等.上海市内科系统延续护理开展现状访谈[J].护理学杂志,2014,29(21):85-87.
[10] 汪晖,杨纯子,徐蓉,等.46所综合性医院出院患者延伸护理服务需求的调查分析[J].护理学杂志,2015,30(9):93-95.
[11] 王莉,孙晓,张寸,等.医院-社区联动下的慢性病延续性照护现状研究进展[J].护理研究,2016,30(32):3973-3976.
[12] 国家卫生计生委.全国护理事业发展规划(2016—2020年)[EB/OL].(2016-11-18)[2018-10-05].http://www.ndrc.gov.cn/fzgggz/fzgh/ghwb/gjjgh/201707/t20170720_855027.html.
[13] KOTTER T,BLOZIK E,SCHERER M.Methods for the guideline-based development of quality indicators-a systematic review[J].Implement Sci,2012,7:21.
[14] YAMAGISHI M,KANDA K,TAKEMURA Y.Methods developed to elucidate nursing related adverse events in Japan[J].J Nurs Manag,2003,11(3):168-176.
[15] KUNAVIKTIKUL W,ANDERS R L,CHONTAWAN R,et al.Development of indicators to assess the quality of nursing care in Thailand[J].Nurs Health Sci,2005,7(4):273-280.
[16] 施雁.护理质量指标的相关概念与应用[J].上海护理,2015,15(2):91-96.
[2] 王娟,黄卡,林田,等.基于家庭医生责任制的脑卒中病人延续性照护模式的探讨[J].护理研究,2016,30(31):3939-3941.
[3] CAO X Y,TIAN L,CHEN L,et al.Effects of a hospital community partnership transitional program in patients with coronary heart disease in Chengdu,China:a randomized controlled trial[J].Jpn J Nurs Sci,2017,14(4):320-331.
[4] 陈燕.北京地区慢性心力衰竭患者延续性照护模式的初步探索[D].北京:北京协和医学院,2013.
[5] LEPPIN A L,GIONFRIDDO M R,KESSLER M,et al.Preventing 30-day hospital readmissions:a systematic review and meta-analysis of randomized trials[J].JAMA Intern Med,2014,174(7):1095-1107.
[6] JEFFS L,LAW M P,STRAUS S,et al.Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process[J].BMJ Qual Saf,2013,22(12):1014-1024.
[7] 陈璐,奚兴,JANET S.三级医院延续性护理服务质量评价指标体系的构建[J].护理学杂志,2015,30(10):94-97.
[8] 卫生部.中国护理事业发展规划纲要(2011—2015年).[EB/OL].(2011-12-31)[2018-10-05].http://www.moh.gov.cn/mohyzs/s3593/201201/53897.shtml.
[9] 施雁,孙晓,朱晓萍,等.上海市内科系统延续护理开展现状访谈[J].护理学杂志,2014,29(21):85-87.
[10] 汪晖,杨纯子,徐蓉,等.46所综合性医院出院患者延伸护理服务需求的调查分析[J].护理学杂志,2015,30(9):93-95.
[11] 王莉,孙晓,张寸,等.医院-社区联动下的慢性病延续性照护现状研究进展[J].护理研究,2016,30(32):3973-3976.
[12] 国家卫生计生委.全国护理事业发展规划(2016—2020年)[EB/OL].(2016-11-18)[2018-10-05].http://www.ndrc.gov.cn/fzgggz/fzgh/ghwb/gjjgh/201707/t20170720_855027.html.
[13] KOTTER T,BLOZIK E,SCHERER M.Methods for the guideline-based development of quality indicators-a systematic review[J].Implement Sci,2012,7:21.
[14] YAMAGISHI M,KANDA K,TAKEMURA Y.Methods developed to elucidate nursing related adverse events in Japan[J].J Nurs Manag,2003,11(3):168-176.
[15] KUNAVIKTIKUL W,ANDERS R L,CHONTAWAN R,et al.Development of indicators to assess the quality of nursing care in Thailand[J].Nurs Health Sci,2005,7(4):273-280.
[16] 施雁.护理质量指标的相关概念与应用[J].上海护理,2015,15(2):91-96.