运用脆弱老年人护理质量评估指标来衡量医院对脆弱老年人的护理质量。

Using assessing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders.

作者信息

Arora Vineet M, Johnson Martha, Olson Jared, Podrazik Paula M, Levine Stacie, Dubeau Catherine E, Sachs Greg A, Meltzer David O

机构信息

Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.

出版信息

J Am Geriatr Soc. 2007 Nov;55(11):1705-11. doi: 10.1111/j.1532-5415.2007.01444.x.

DOI:10.1111/j.1532-5415.2007.01444.x

PMID:17979894

Abstract

OBJECTIVES

To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).

DESIGN

Prospective cohort study.

SETTING

Single academic medical center.

PARTICIPANTS

Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status.

MEASUREMENTS

Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse).

RESULTS

Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3-83.7% vs 75.8%, 95% CI=70.5-81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3-83.7 vs 31.4% 95% CI=27.5-35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission.

CONCLUSION

Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care.

摘要

目的

使用基于脆弱老年人护理评估（ACOVE）质量指标（QIs）的措施，评估住院脆弱老年人的护理质量。

设计

前瞻性队列研究。

地点

单一学术医疗中心。

参与者

在芝加哥大学普通内科住院服务中住院的65岁及以上患者，这些患者使用脆弱老年人调查-13（VES-13）被定义为脆弱，VES-13是一种基于年龄、自我报告的健康状况和功能状态的经过验证的工具。

测量

使用基于ACOVE的护理过程措施进行住院患者访谈和病历审查，这些措施涉及综合医院护理和老年常见病症（如压疮、痴呆和谵妄）中的16个QIs；计算护理过程类型（筛查、诊断和治疗）和提供者类型（医生、护士）的依从率。

结果

845名老年患者中有600名（71%）参与。其中，349名（58%）根据VES-1134444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444得分被认为是脆弱的。有328份（94%）病历可供审查。普通医疗护理的QIs达标率显著高于压疮护理（81.5%，95%置信区间（CI）=79.3-83.7%对75.8%，95%CI=70.5-81.1%，P=0.04）以及谵妄和痴呆护理（81.5%，95%CI=79.3-83.7对31.4%，95%CI=27.5-35.2%，P<0.01）。根据标准护理评估表，护士对某些筛查指标（疼痛、营养、功能状态、压疮风险）的依从率较高（与医生相比，P<0.001），尽管在有功能限制的患者中，护士入院时对功能限制的评估往往与患者入院时报告的限制情况不一致。