Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study
Autor: | Rebecca J. Asch, Theodore J. Iwashyna, David A. Asch, Derek C. Angus, Jeremy M. Kahn, Gordon D. Rubenfeld |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2008 |
Předmět: |
Adult
medicine.medical_specialty Critical Care Attitude of Health Personnel media_common.quotation_subject Health informatics Regional Health Planning Health administration Interviews as Topic 03 medical and health sciences 0302 clinical medicine Nursing medicine Revenue Humans 030212 general & internal medicine Referral and Consultation media_common business.industry Nursing research Public health Health Policy lcsh:Public aspects of medicine Administrative Personnel 030208 emergency & critical care medicine lcsh:RA1-1270 United States 3. Good health Intensive Care Units Content analysis Family medicine business Delivery of Health Care Autonomy Qualitative research Research Article |
Zdroj: | BMC Health Services Research, Vol 8, Iss 1, p 239 (2008) BMC Health Services Research |
ISSN: | 1472-6963 |
Popis: | Background Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States. Methods We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions. Results We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers. Conclusion Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care. |
Databáze: | OpenAIRE |
Externí odkaz: |