Renom-Guiteras Anna, Uhrenfeldt Lisbeth, Meyer Gabriele, Mann Eva
School of Nursing Science, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
BMC Geriatr. 2014 Jun 22;14:80. doi: 10.1186/1471-2318-14-80.
Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.
Systematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.
Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents' characteristics prior to admission (n = 6), residents' or families' wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.
Most assessment tools are not comprehensive and do not take into account residents' individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.
长期护理机构的居民有较高的急性护理入院风险。在各项研究中，对不适当转诊频率的估计差异很大，并且使用了各种评估工具。本研究的目的是系统回顾和描述国际上现有的用于确定长期护理居民住院适宜性的评估工具。
对两个数据库（PubMed和CINAHL®）的文献进行系统回顾。检索涵盖七种语言，时间跨度为2000年1月至2012年12月。如果使用了任何针对长期护理居民住院和/或急诊科入院适宜性的评估工具，则纳入所有定量研究。由两对独立的研究人员提取数据。
纳入了29篇文章，涵盖1991年至2009年的研究时间段。被认为不适当的入院比例在2%至77%之间。在各项研究中，使用了16种不同的评估工具；所有工具在某种程度上都基于专家意见；六种工具还考虑了已发表的文献或对患者数据的解读。工具之间的差异取决于所研究的概念、形式和应用以及评估的方面。总体而言，评估工具涵盖六个方面：特定的医学诊断（8种工具进行评估）、症状的急性程度/严重程度（7种）、入院前居民的特征（6种）、居民或家属的意愿（3种）、护理计划的存在情况（1种）以及资源的可用性或需求（10种）。大多数工具根据一个满足的项目来判断适宜性；五种工具根据各方面的平衡来判断适宜性。五种工具仅涵盖这些方面中的一个，只有六种工具考虑了四个或更多方面。关于这些工具的心理测量特性的信息很少。
大多数评估工具不全面，没有考虑居民的个体因素，如入院前居民的特征以及居民或家属的意愿。现有工具的可推广性未知。需要进一步开展研究以开发一种基于证据、全面且可推广到不同地区或国家的工具，以便评估长期护理居民住院的适宜性。
