Boyle Diane K, Jayawardhana Ananda, Burman Mary E, Dunton Nancy E, Staggs Vincent S, Bergquist-Beringer Sandra, Gajewski Byron J
Fay W. Whitney School of Nursing, University of Wyoming, Dept. 3065, 1000 E. University Ave., Laramie, WY 82071-2000, USA.
Department of Mathematics, Pittsburg State University, 1701 S. Broadway, Pittsburg, KS, 66762, USA.
Int J Nurs Stud. 2016 Nov;63:73-81. doi: 10.1016/j.ijnurstu.2016.08.020. Epub 2016 Sep 1.
Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement.
The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index.
Two-phase measure development study.
5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors during the year 2013.
The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling.
The Pressure Ulcer and Fall Rate Quality Composite Index=100-PUR-FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores.
The Pressure Ulcer and Fall Rate Quality Composite Index is a step toward providing a more holistic perspective of unit level nursing quality than individual measures and may help nurses nursing administrators obtain a broader view of which patient care units are the higher and lower performers. Further study is needed to examine the usability of the Pressure Ulcer and Fall Rate Quality Composite Index.
综合指标是将两个或多个单独指标的优势结合起来的单一度量，为评估医疗服务提供者的绩效以及跨科室和医院进行比较提供更广泛、易于使用的度量，以支持质量改进。
本研究旨在开发一个科室层面的住院患者综合护理质量绩效指标——压疮与跌倒率质量综合指标。
分两阶段的指标开发研究。
2013年参与国家护理质量指标数据库的美国857家医院中的5144个患者护理科室。
压疮与跌倒率质量综合指标分两个阶段开发。在第一阶段，使用效用函数和广义惩罚分析生成公式。具有医疗质量测量经验的专家提供指标等效点。在第二阶段，基于压疮与跌倒率质量综合指标与其他变量之间的假设关系，使用两级（科室、医院）分层线性混合模型收集初始效度证据。
压疮与跌倒率质量综合指标=100 - PUR - FR，其中PUR为压疮发生率，FR为总跌倒率。分数越高表明质量越好。布兰德-奥特曼图显示了专家对之间的一致性，并为公式的评分者间信度提供了证据。验证过程表明，更高的注册护士技能组合、更高比例的拥有护理学学士学位或更高学位的注册护士、更高比例的拥有国家专业认证的注册护士以及更低比例的机构工作人员提供的工时与更高的压疮与跌倒率质量综合指标得分显著相关。更高比例的有医院获得性压疮风险的科室患者以及更高的科室身体约束使用率与更高的压疮与跌倒率质量综合指标得分无关。
压疮与跌倒率质量综合指标是朝着比单独指标更全面地反映科室层面护理质量迈出的一步，可能有助于护士和护理管理人员更全面地了解哪些患者护理科室表现较好，哪些表现较差。需要进一步研究以检验压疮与跌倒率质量综合指标的实用性。
