目的基于现有证据,综合评述在提供急性期照护的医院实施全方位健康照护国家标准的方法、挑战和促进因素及影响。方法采用Whittemore和Knafl的五步法,系统检索Medline、CINAHL Cochrane图书馆、Scopus和Web of Science数据库,并检索灰色...目的基于现有证据,综合评述在提供急性期照护的医院实施全方位健康照护国家标准的方法、挑战和促进因素及影响。方法采用Whittemore和Knafl的五步法,系统检索Medline、CINAHL Cochrane图书馆、Scopus和Web of Science数据库,并检索灰色文献,包括政府文件和网页,文献发布时间限定为2000年1月1日至2023年1月31日。对纳人研究进行JBI质量审查和定性内容分析。结果该综述共纳入16篇文献,包括5篇原始研究、5篇政府报告和6个政府官方网页。澳大利亚、挪威和英国均有全面护理国家标准。澳大利亚和英国有明确的标准实施框架,澳大利亚标准包含减少患者伤害的特别组成部分。有限的研究表明,在医院实施全方位健康照护国家标准的挑战包括:实施流程化、临终关怀行动.减少患者伤害及多学科团队制定全方位健康照护计划方面的困难,缺乏标准化照护计划和以患者为中心目标的文件,以及繁重的文书工作。实施的促进因素包括:创建使用标准化沟通框架进行交接的照护计划模板,提高文书工作、临床决策和直接患者护理的效率,以及患者和专业人员之间的主动协作。澳大利亚引人全方位健康照护国家标准显示对患者预后有积极的影响。结论澳大利亚、挪威和英国的全方位健康照护国家标准的组成和实施方法略有不同。需要进行更多相关研究,评估在提供急性期照护的医院实施全方位健康照护国家标准的挑战和促进因素,以及实施效果。展开更多
AIM: To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating me-dical therapy after Crohn's disease(CD) surgery at a tertiary care referral center.METHODS: CD patients having ...AIM: To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating me-dical therapy after Crohn's disease(CD) surgery at a tertiary care referral center.METHODS: CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery. RESULTS: Eighty-eight patients met study inclusion criteria with 92%(n = 81) of patients returning for surgical follow-up compared to only 41%(n = 36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P < 0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery.CONCLUSION: Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.展开更多
Objective:This study explores geographic,system,and organizational constructs that predict medical care teams’willingness to administer fluoride varnish and conduct oral health risk assessments.Methods:A cross-sectio...Objective:This study explores geographic,system,and organizational constructs that predict medical care teams’willingness to administer fluoride varnish and conduct oral health risk assessments.Methods:A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September,2016.Bivariate and multivariate analyses were used to examine un-known correlates of oral health prevention and intervention at geographic,organizational,and sys-tem levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations.Results:A convenience cohort(n=560)from 44 states was examined.Most(68.7%,n=385)agreed with the dependent variable“medical providers at our site,or part of our network,are admin-istering fluoride varnish and identifying oral health risk factors in the majority of patients seen.”In bivariate analysis,organization type(P=0.0067),having successful referral systems(P<0.0001),and electronic health record(EHR)utility(P<0.0001)were associated with the dependent vari-able.No geographic indicators were significant.All referral system indicators were significant in multivariate analysis.Dependable referrals(P<0.0001),EHR utility(P=0.0054),and type of re-ferral(P=0.0009)were predictors of the dependent variable.The odds of those reporting a depend-able referral system and dependent variable agreement were 4.5 times greater than for those who lacked dependable referral systems(odds ratio 4.54,confidence interval 2.79-7.39).The odds of those who had dependable EHRs and dependent variable agreement were 2.4 times greater than for those who lacked useful EHRs(odds ratio 2.4,confidence interval 1.29-4.37).Conclusion:The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated p展开更多
基金supported by Graduate School Scholarships from the University of QueenslandThis work is part of the project“Improving quality of care for people with dementia in the acute care setting(eQC)”which is funded by the National Health and Medical Research Council of the Australian Government(ID:APP1140459).
文摘目的基于现有证据,综合评述在提供急性期照护的医院实施全方位健康照护国家标准的方法、挑战和促进因素及影响。方法采用Whittemore和Knafl的五步法,系统检索Medline、CINAHL Cochrane图书馆、Scopus和Web of Science数据库,并检索灰色文献,包括政府文件和网页,文献发布时间限定为2000年1月1日至2023年1月31日。对纳人研究进行JBI质量审查和定性内容分析。结果该综述共纳入16篇文献,包括5篇原始研究、5篇政府报告和6个政府官方网页。澳大利亚、挪威和英国均有全面护理国家标准。澳大利亚和英国有明确的标准实施框架,澳大利亚标准包含减少患者伤害的特别组成部分。有限的研究表明,在医院实施全方位健康照护国家标准的挑战包括:实施流程化、临终关怀行动.减少患者伤害及多学科团队制定全方位健康照护计划方面的困难,缺乏标准化照护计划和以患者为中心目标的文件,以及繁重的文书工作。实施的促进因素包括:创建使用标准化沟通框架进行交接的照护计划模板,提高文书工作、临床决策和直接患者护理的效率,以及患者和专业人员之间的主动协作。澳大利亚引人全方位健康照护国家标准显示对患者预后有积极的影响。结论澳大利亚、挪威和英国的全方位健康照护国家标准的组成和实施方法略有不同。需要进行更多相关研究,评估在提供急性期照护的医院实施全方位健康照护国家标准的挑战和促进因素,以及实施效果。
文摘AIM: To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating me-dical therapy after Crohn's disease(CD) surgery at a tertiary care referral center.METHODS: CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery. RESULTS: Eighty-eight patients met study inclusion criteria with 92%(n = 81) of patients returning for surgical follow-up compared to only 41%(n = 36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P < 0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery.CONCLUSION: Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.
文摘Objective:This study explores geographic,system,and organizational constructs that predict medical care teams’willingness to administer fluoride varnish and conduct oral health risk assessments.Methods:A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September,2016.Bivariate and multivariate analyses were used to examine un-known correlates of oral health prevention and intervention at geographic,organizational,and sys-tem levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations.Results:A convenience cohort(n=560)from 44 states was examined.Most(68.7%,n=385)agreed with the dependent variable“medical providers at our site,or part of our network,are admin-istering fluoride varnish and identifying oral health risk factors in the majority of patients seen.”In bivariate analysis,organization type(P=0.0067),having successful referral systems(P<0.0001),and electronic health record(EHR)utility(P<0.0001)were associated with the dependent vari-able.No geographic indicators were significant.All referral system indicators were significant in multivariate analysis.Dependable referrals(P<0.0001),EHR utility(P=0.0054),and type of re-ferral(P=0.0009)were predictors of the dependent variable.The odds of those reporting a depend-able referral system and dependent variable agreement were 4.5 times greater than for those who lacked dependable referral systems(odds ratio 4.54,confidence interval 2.79-7.39).The odds of those who had dependable EHRs and dependent variable agreement were 2.4 times greater than for those who lacked useful EHRs(odds ratio 2.4,confidence interval 1.29-4.37).Conclusion:The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated p
