Loizzo M, Cuccurullo O, Gallo F
Head of the Quality Unit, Accreditation, Research and Innovation, Hospital of Cosenza, Cosenza, Italy.
Operative Geriatrics Unit, Hospital of Cosenza, Cosenza, Italy.
Ann Ig. 2017 Mar-Apr;29(2):141-150. doi: 10.7416/ai.2017.2141.
Many studies in literature, indicate that the prognosis of hospitalized elderly patients is substantially related to the presence of concomitant diseases (multi-morbidity) along with physical, cognitive, biological and social functional impairments. These patients, therefore, require the expertise of a multi-professional and multi-disciplinary team operating in a Multi Dimensional Rating (MDR). MDR explores the multiple facets of the elderly and it is considered the tool of choice to define prognosis, especially in the case of compromised elderly patients with clinical or functional problems. MDR is satisfactory and it can be applied if it is included in a diagnostic therapeutic care pathway, which is a management tool that achieves best practices and efficiency in healthcare professionals that learn from each other.
Considering that about 80% of elderly patients has anemia, a condition often underestimated, it has been necessary to create a Diagnostic and Therapeutic Care Pathway (DTCP) with the goal to increase the level of medical awareness on this specific medical problem, and outline clear care paths for the patient. The DTCP in question was promoted by the Geriatric ward of Cosenza's Hospital by setting up a multidisciplinary working group and editing an algorithm. Indicators and standards were chosen to evaluate performance and procedures: all this has required several meetings and counseling sessions between the coordinator of DTCP and the Quality and Accreditation Operative Unit (OU). The verification of the path activities has been realized by examining the documented evidence produced.
Preparing the indicators and standards for anemia, DTCP was a particularly challenging step of the work. DTCP has been correctly applied to more than 50% of cases, but was inapplicable to patients who either were very sick or had a very mild form of anemia.
The analysis of this first phase shows that DTCP is both beneficial to the patient (framed and accompanied in her/his hospitalization and subsequent follow-up) and it facilitates the work of the physician. However, there are some limitations in its application because it is not always possible to measure indicators in every ward that participates in the DTCP.
文献中的许多研究表明，住院老年患者的预后与伴随疾病（多重疾病）的存在以及身体、认知、生物和社会功能障碍密切相关。因此，这些患者需要一个在多维评估（MDR）中运作的多专业和多学科团队的专业知识。MDR探索老年人的多个方面，被认为是定义预后的首选工具，特别是在患有临床或功能问题的老年患者中。如果MDR包含在诊断治疗护理路径中，它是令人满意且可以应用的，诊断治疗护理路径是一种管理工具，能在相互学习的医疗保健专业人员中实现最佳实践和效率。
考虑到约80%的老年患者患有贫血，这一情况常被低估，有必要创建一个诊断治疗护理路径（DTCP），目标是提高对这一特定医疗问题的医学认识水平，并为患者勾勒清晰的护理路径。相关的DTCP由科森扎医院的老年病房推动，通过组建一个多学科工作组并编辑一个算法来实现。选择指标和标准来评估绩效和程序：所有这些都需要DTCP协调员与质量和认证操作单元（OU）之间进行多次会议和咨询。通过检查所产生的书面证据来实现对路径活动的核查。
为贫血准备指标和标准时，DTCP是工作中特别具有挑战性的一步。DTCP已正确应用于超过50%的病例，但不适用于病情非常严重或贫血形式非常轻微的患者。
对第一阶段的分析表明，DTCP对患者（在其住院及随后的随访中得到规划和陪伴）有益，并且便于医生的工作。然而，其应用存在一些局限性，因为并非总是能够在参与DTCP的每个病房中测量指标。
