Division of Emergency Medicine, Washington University in St. Louis, MO, USA.
Acad Emerg Med. 2011 Jun;18(6):644-54. doi: 10.1111/j.1553-2712.2011.01092.x.
Geriatric adults represent an increasing proportion of emergency department (ED) users and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus on the development of quality indicators (QIs) to define a minimal standard of care.
The original objective of this project was to develop additional ED-specific QIs for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence were insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop QIs in the future.
Each domain was assigned one or two content experts who created potential QIs based on a systematic review of the literature, supplemented by expert opinion. Candidate QIs were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback.
High-quality evidence based on patient-oriented outcomes was insufficient or nonexistent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (three), screening and prevention (two), and functional assessment (three) are presented based on proposed QIs that the majority of participants accepted.
In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future QIs within these domains are described.
老年患者在急诊科（ED）就诊人群中所占比例不断增加，他们可能特别容易受到急性疾病的影响。医疗保健提供者最近开始关注质量指标（QIs）的制定，以确定最低护理标准。
该项目的最初目标是在药物管理、筛查和预防以及功能评估等领域为老年患者制定额外的 ED 特定 QI，但证据的数量和质量不足以证明这三个领域的最低护理标准是明确的。因此，作者修改了项目目标，以确定这三个领域内的关键研究机会，以便将来制定 QI。
每个领域都分配了一到两名内容专家，他们根据文献的系统综述制定潜在的 QI，并辅以专家意见。然后，由四个小组审查候选 QI：学术急诊医学协会（SAEM）老年工作组、SAEM 老年兴趣小组，以及 2008 年 SAEM 年会和 2009 年美国老年学会年会的听众，使用匿名观众响应系统技术以及口头和书面反馈。
所有三个领域都缺乏基于患者为导向的结果的高质量证据。参与的听众未能就任何提议的 QI 达成共识。基于大多数参与者接受的提议 QI，提出了药物管理（三个）、筛查和预防（两个）以及功能评估（三个）领域的关键研究问题。
在评估药物管理、筛查和预防以及功能评估的最低护理标准，以系统地制定老年 QI 时，缺乏有说服力的临床研究证据。描述了这些领域内制定未来 QI 所必需的以患者为导向的研究问题。
