Department of Clinical Epidemiology, Biostatistics and Health Services Research, Melbourne Health, The University of Melbourne and The Royal Melbourne Hospital, Melbourne, Australia.
BMC Health Serv Res. 2011 Oct 20;11:281. doi: 10.1186/1472-6963-11-281.
Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals.
METHODS/DESIGN: The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel.
The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system.
入住急性护理医院的体弱老年人面临一系列不良后果的风险，包括老年综合征，尽管有针对性的护理策略可以改善这些患者的健康结果。因此，评估医院间的绩效差异对于规划和资源改善计划非常重要。临床质量结果指标为随时间和医院间的绩效变化提供了一种机制，但迄今为止，急性护理环境中尚未常规使用此类指标。使用质量指标的一个障碍是缺乏对常规收集的临床数据的访问。interRAI 急性护理（AC）评估系统支持在医院日常实践中对老年人进行全面的老年评估，并包括与老年综合征相关的过程和结果数据。本文报告了为急性护理医院制定老年护理质量指标的研究方案。
方法/设计：该研究将分三个阶段进行：1. 基于文献回顾和专家小组咨询，制定初步的包容性质量指标集；2. 一项包括 9 家澳大利亚医院的 480 名 70 岁或以上患者的前瞻性现场研究。每个患者将在入院和出院时使用 interRAI AC 进行评估，并进行日常监测以观察结果。病历将由独立审核员审核；3. 对确定的质量指标集进行分析和编制，包括专家小组进行的两轮匿名投票，以确定质量指标的纳入。
本方案中提出的质量指标方法有四个明显优于以往努力的优点：质量指标侧重于结果；它们可以作为常规应用的临床信息和决策支持系统的一部分收集；临床数据将是可靠的，并有助于更好地了解医院对老年患者护理的差异；质量指标将具有国际相关性，因为它们将基于国际认可的临床系统 interRAI 评估工具构建。
