Moxey Elizabeth D, O'Connor John P, White Elizabeth, Turk Barbara, Nash David B
Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107-5099, USA.
Jt Comm J Qual Improv. 2002 Apr;28(4):180-96. doi: 10.1016/s1070-3241(02)28018-9.
Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts. A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities.
Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social.
A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.
长期护理（LTC）中的质量测量面临诸多挑战：缺乏统一的质量定义、存在多个测量领域、众多潜在视角以及强调仅对低质量进行测量的监管影响。研究工作尚未解决测量问题；然而，长期护理机构的运营者必须将当前质量测量的先进技术作为其质量改进工作的基础。一个大型综合医疗服务系统的管理层委托了一个项目，该系统拥有强大的长期护理机构网络，希望基于一种能提供以居民为中心的全面质量评估的测量工具来实施持续质量改进流程。因此，该项目的目标是确定质量领域，为每个领域选择并改编经过验证的测量工具，对数据收集过程进行试点测试，并为长期护理机构制定一份运营质量概况报告格式。
利用专家小组和长期护理研究文献，开发了一种运营测量工具，该工具由四个质量领域组成：组织、临床、环境和社会。
在两家护理机构进行的试点研究表明，数据收集过程可以在资源和预算紧张的情况下实施。运营质量评估工具的开发使管理层能够对不同机构有一致的看法，详细关注居民所感知的护理质量。该工具允许评估随时间的趋势并与外部标准进行比较。
