Weathers Elizabeth, O'Caoimh Rónán, O'Sullivan Ronan, Paúl Constança, Orfilia Frances, Clarnette Roger, Fitzgerald Carol, Svendrovski Anton, Cornally Nicola, Leahy-Warren Patricia, Molloy D William
Clinical Research Nurse, Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital and the Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway City, Ireland.
Geriatrician, Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital and the Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway City, Ireland.
Br J Community Nurs. 2016 Sep;21(9):469-75. doi: 10.12968/bjcn.2016.21.9.469.
Predicting risk of adverse healthcare outcomes is important to enable targeted delivery of interventions. The Risk Instrument for Screening in the Community (RISC), designed for use by public health nurses (PHNs), measures the 1-year risk of hospitalisation, institutionalisation and death in community-dwelling older adults according to a five-point global risk score: from low (score 1,2) to medium (3) to high (4,5). We examined the inter-rater reliability (IRR) of the RISC between student PHNs (n=32) and expert raters using six cases (two low, medium and high-risk), scored before and after RISC training. Correlations increased for each adverse outcome, statistically significantly for institutionalisation (r=0.72 to 0.80, p=0.04) and hospitalisation (r=0.51 to 0.71, p<0.01) but not death. Training improved accuracy for low-risk but not all high-risk cases. Overall, the RISC showed good IRR, which increased after RISC training. That reliability fell for some high-risk cases suggests that the training programme requires adjustment to improve IRR further.
预测不良医疗结果的风险对于有针对性地实施干预措施至关重要。社区筛查风险工具（RISC）由公共卫生护士（PHN）使用，根据五点全球风险评分衡量社区居住老年人的住院、机构收容和死亡的1年风险：从低（评分1、2）到中（3）至高（4、5）。我们使用六个案例（两个低、中、高风险案例），在RISC培训前后进行评分，检验了学生PHN（n = 32）和专家评分者之间RISC的评分者间信度（IRR）。每种不良结果的相关性均增加，机构收容（r = 0.72至0.80，p = 0.04）和住院（r = 0.51至0.71，p <0.01）在统计学上显著增加，但死亡情况并非如此。培训提高了低风险案例的准确性，但并非所有高风险案例。总体而言，RISC显示出良好的IRR，在RISC培训后有所提高。一些高风险案例的信度下降表明培训计划需要调整以进一步提高IRR。
