Wald Heidi L, Leykum Luci K, Mattison Melissa L P, Vasilevskis Eduard E, Meltzer David O
Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, Colorado.
J Hosp Med. 2015 May;10(5):318-27. doi: 10.1002/jhm.2356. Epub 2015 Apr 16.
Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training.
医院医生和其他急性病护理提供者受到证据空白的限制,这些空白涉及急性病老年人群的需求。医院医学协会发起了老年患者急性护理优先事项设定合作项目,以制定一个专注于弥合这一差距的研究议程。在以患者为中心的结果研究所确定和优先排序研究领域的框架指导下,我们采用了詹姆斯·林德联盟开发的一种方法,让不同的利益相关者参与研究议程的设定过程。该合作项目的工作通过四个步骤进行:召集、咨询、整理和排序。首先,指导委员会于2013年5月召集了18个利益相关者组织组成的合作团队。接下来,利益相关者组织对成员进行了调查,以确定老年患者急性护理中重要的未解决问题,共收到来自580人的1299份回复。最后,经过广泛且结构化的整理和排序过程,得出了以下领域的10个研究问题的最终清单:临终关怀规划、护理过渡、谵妄、痴呆、抑郁、药物治疗、护理模式、身体功能、手术和培训。鉴于住院患者人口结构的变化、老年医学培训有限的劳动力以及为急性病老年患者提供临床决策依据的证据空白,所确定的研究问题在指导未来研究工作以改善老年住院患者护理和丰富培训方面应获得最高优先级。