摘要
目的:构建安宁疗护分级转诊服务体系并评价其应用效果,为临床进行系统、规范的安宁疗护患者分级转诊提供参考。方法:通过文献研究、主题分析、德尔菲专家函询法形成安宁疗护分级转诊服务体系。采用类实验研究法,随机抽取南京市参与安宁疗护分级转诊服务的医疗机构中的80名患者,进行体系运行前后的向上转诊率、向下转诊率、患者家属对转诊服务满意度及患者死亡质量的调查与统计分析。结果:2轮专家函询的专家积极系数均为100.0%;专家权威系数为0.800和0.825;肯德尔协调系数分别为0.141和0.632(P<0.01);最终确定安宁疗护分级转诊服务体系包括一级指标4项(各级医疗机构开展安宁疗护标准、患者转诊标准、信息共享机制、质量控制指标)、二级指标14项、三级指标70项。且安宁疗护分级转诊服务体系提高了向下转诊率、降低了向上转诊率、提高了死亡质量(P<0.05)。结论:安宁疗护分级转诊服务体系具有科学性、可靠性、专科性和实用性,能为临床更好地开展安宁疗护患者分级转诊提供参考。
Objective:To develop a hospice hierarchical referral service system and to evaluate its effects with the expectation of support provision for the development of hospice referral mechanisms at a later stage.Methods:The hospice hierarchical referral service system was determined by literature review,thematic analysis,Delphi expert inquire method.A quasi-experimental study design was adopted and 80 patients were randomly recruited from the medical institutions which were involved in the hierarchical referral service system in Nanjing.The upward and downward referral rate of the patients,satisfaction of patient's family members on the hierachical referral service,and the quality of death were collected and compared.Results:The positivity coefficients of two rounds of expert inquiries were both 100.0%.The authority coefficient of experts was 0.800 and 0.825,and the coordination coefficients were 0.141 and 0.632,respectively(P<0.01).The finalized hospice hierarchical referral service system included 4 first-level indicators(standards for hospice care in all levels of healthcare institutions,referral standards of patients,information-sharing mechanism,and quality control system),14second-level indicators,and 70 third-level indicators.The upward and downward referral rate,and quality of death were all optimized.Conclusion:The hospice hierarchical referral service system is scientific,reliable,specialized,and practical,which can provide important reference for better implementation of hospice hierarchical referral service.
作者
周玉洁
袁玲
武丽桂
李善萍
董珊
ZHOU Yujie;YUAN Ling;WU Ligui;LI Shanping;DONG Shan(School of Nursing,Nanjing University of Traditional Chinese Medicine,Nanjing,210000,China)
出处
《中国护理管理》
CSCD
北大核心
2024年第5期675-680,共6页
Chinese Nursing Management
关键词
安宁疗护
分级转诊
服务体系
德尔菲专家函询法
hospice care
hierarchical referral
service system
Delphi expert inquire method
