Rubino Alessandro, Leigheb Fabrizio, Rinaldi Carmela, Di Dio Angelo, Knesse Sanita, Donnarumma Chiara, Panella Massimiliano
Dipartimento di Medicina Traslazionale, Sezione di Igiene, Università del Piemonte Orientale, Novara, Italia.
Ig Sanita Pubbl. 2016 Nov-Dec;72(6):533-546.
The aim of this observational descriptive study was to identify the main international models evaluating the quality of nursing homes for non self-sufficient elderly persons, and to apply them in the Italian health system. Firstly, a bibliographic search of institutional websites and Pubmed-Medline was performed to identify the main international models. Secondly, three variables were chosen to evaluate the level of implementability of the models: (1) frequency of use of quality indicators in the international models; (2) degree of constructability of the models in two Italian nursing homes; (3) perceived relevance of the indicators used by the chosen models, by nursing home workers. Thirdly, the chosen models were evaluated. Three international models were identified, respectively used in USA, Canada and Australia. About 80% of the indicators used by the three models were constructable in the two Italian nursing homes that were evaluated. The two nursing homes were "promoted" according to the Canadian model, "better than sufficient" according to the Australian model, but "failed" when US model indicators were applied. The poorest performances in the two Italian nursing homes, with respect to international quality standards, were related to indicators of incontinence, physical restraints (1,1% for USA and 13% for Canada and Australia, versus 55% in one of the nursing homes and 30% in the second home), diagnosis of depressive symptoms, and antipneumococcical vaccination (0% in the two nursing homes, in comparison with the 93,8% in the USA). A low level of performance in prevention and safety matters was identified, while performance was higher for aspects warranted by law. The survey also revealed thatnursing home workers' perceptions of the utility of specific indicators were often based on habit rather than on the actual relevance of care indicators. The development of a model of quality of care that offers a multidimensional evaluation of the level of performance of Italian nursing homes is needed.
这项观察性描述性研究的目的是识别评估非自理老年人养老院质量的主要国际模式，并将其应用于意大利卫生系统。首先，对机构网站和PubMed-Medline进行文献检索，以识别主要的国际模式。其次，选择三个变量来评估这些模式的可实施水平：（1）国际模式中质量指标的使用频率；（2）这两种模式在两家意大利养老院中的可构建程度；（3）养老院工作人员对所选模式所使用指标的感知相关性。第三，对所选模式进行评估。识别出三种分别在美国、加拿大和澳大利亚使用的国际模式。这三种模式所使用的约80%的指标在接受评估的两家意大利养老院中是可构建的。根据加拿大模式，这两家养老院被“提升”；根据澳大利亚模式，它们“优于足够水平”；但应用美国模式指标时则“不合格”。就国际质量标准而言，这两家意大利养老院表现最差的方面与失禁、身体约束（美国为1.1%，加拿大和澳大利亚为13%，而其中一家养老院为55%，另一家为30%）、抑郁症状诊断以及抗肺炎球菌疫苗接种（两家养老院均为0%，而美国为93.8%）的指标有关。在预防和安全方面发现表现水平较低，而在法律要求的方面表现较高。该调查还显示，养老院工作人员对特定指标效用的认知往往基于习惯，而非护理指标的实际相关性。需要开发一种护理质量模式，对意大利养老院的表现水平进行多维度评估。
