急性老年创伤质量改进干预前后提供的护理质量
Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma.
作者信息
Min Lillian, Cryer Henry, Chan Chiao-Li, Roth Carol, Tillou Areti
机构信息
University of Michigan Medical School, Ann Arbor, MI; Geriatric Research Education and Clinical Center (GRECC), VA Health Care Systems, Ann Arbor, MI.
Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA.
出版信息
J Am Coll Surg. 2015 May;220(5):820-30. doi: 10.1016/j.jamcollsurg.2014.12.041. Epub 2015 Jan 9.
BACKGROUND
Older trauma-injury patients had improved recovery after we implemented routine geriatric consultation for patients aged 65 years and older admitted to the trauma service of a Level I academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown.
STUDY DESIGN
We conducted a prospective observation comparing medical care after (December 2007 to November 2009) vs before (December 2006 to November 2007) implementation of the geriatric consult-based intervention. To measure quality of care (QOC), we used 33 previously validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 geriatric consult (GC) vs 71 control group patients. As prespecified subgroup analyses, we aggregated QIs by type: geriatric (eg, delirium screening) vs nongeriatric condition-based care (eg, thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and nongeriatric QOC scores for each patient (number of QIs passed/number of QIs eligible), and compared patient-level QOC for the GC vs control group, adjusting for age, sex, ethnicity, comorbidity, and injury severity.
RESULTS
Sixty-three percent of the GC patients vs 11% of the control group patients received a geriatric consultation. We evaluated 2,505 QIs overall (1,664 geriatric type and 841 nongeriatric QIs). In general, fewer geriatric-type QIs were passed than nongeriatric QIs (71% vs 81%; p < 0.001). We provided better overall QOC to the GC (77%) than control group patients (73%; p < 0.05). However, the difference was not statistically significant after multivariable adjustment (p = 0.08). We improved geriatric QOC for the GC (74%) compared with the control group (68%; p < 0.01), a difference that was significant after multivariable adjustment (p = 0.01).
CONCLUSIONS
Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients.
背景
在我们对入住一级学术创伤中心创伤科的65岁及以上患者实施常规老年病会诊后，老年创伤患者的恢复情况有所改善。该干预措施旨在提高老年护理质量。然而，具体哪些护理流程得到了改善尚不清楚。
研究设计
我们进行了一项前瞻性观察研究，比较了基于老年病会诊的干预措施实施后（2007年12月至2009年11月）与实施前（2006年12月至2007年11月）的医疗护理情况。为了衡量护理质量（QOC），我们使用了来自“评估脆弱老年人护理”（ACOVE）研究的33个先前经过验证的护理流程质量指标（QIs），通过查阅76名接受老年病会诊（GC）患者和71名对照组患者的病历进行测量。作为预先设定的亚组分析，我们按类型汇总QIs：老年病相关（如谵妄筛查）与非老年病相关的基于病情的护理（如血栓预防），并比较不同护理类型的QI得分。最后，我们将每个患者的QI得分汇总为总体、老年病和非老年病QOC得分（通过的QI数量/合格的QI数量），并比较GC组与对照组的患者层面QOC，同时对年龄、性别、种族、合并症和损伤严重程度进行调整。
结果
63%的GC组患者接受了老年病会诊，而对照组患者这一比例为11%。我们总共评估了2505个QIs（1664个老年病类型和841个非老年病QIs）。总体而言，通过的老年病类型QIs少于非老年病QIs（71%对81%；p<0.001）。我们为GC组提供的总体QOC（77%）优于对照组患者（73%；p<0.05）。然而，多变量调整后差异无统计学意义（p = 0.08）。与对照组（68%）相比，我们改善了GC组的老年病QOC（74%；p<0.0
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