Institute for Aging Research, Hebrew Senior Life, Boston, USA.
University of Toronto, Toronto, Canada.
BMC Geriatr. 2018 Jul 11;18(1):161. doi: 10.1186/s12877-018-0842-z.
This paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for use in in-patient post-acute environments that use the assessments.
Data Source: MDS 3.0 computerized assessments mandated for all patients admitted to US skilled nursing facilities (SNF) in 2012. In total, 2,380,213 patients were admitted to SNFs for post-acute care. Definition of the QI numerator, denominator and covariate structures were based on MDS assessment items. A regression strategy modeling the "discharge to the community" PAC QI as the dependent variable was used to identify how to bring together a subset of seven candidate PAC QIs for inclusion in a summary scale. Finally, the distributional property of the summary scale (the PAC QI Summary Scale) across all facilities was explored.
The risk-adjusted PAC QIs include indicators of improved status, including measures of early, middle, and late-loss functional performance, as well as measures of walking and changed clinical status and an overall summary functional scale. Many but not all patients demonstrated improvement from baseline to follow-up. However, there was substantial inter-state variation in the summary QI scores across the SNFs.
The set of PAC QIs consist of five functional, two discharge and eight clinical measures, and one summary scale. All QIs can be derived from multiple interRAI assessment tools, including the MDS 2.0, interRAI-LTCF, MDS 3.0, and the interRAI-PAC-Rehab. These measures are appropriate for wide distribution in and out of the United States, allowing comparison and discussion of practices associated with better outcomes.
本文描述了一套综合的功能、临床和出院后急性护理（PAC）质量指标（QIs），并考察了这些指标在美国熟练护理设施（SNF）中的分布情况。这些指标使用了基于 interRAI 评估的可用项目，包括 MDS 3.0，旨在用于使用这些评估的住院后急性护理环境。
数据来源：2012 年，所有入住美国熟练护理设施（SNF）的患者都必须进行 MDS 3.0 计算机评估。总共有 2380213 名患者入住 SNF 接受后急性护理。QI 分子、分母和协变量结构的定义基于 MDS 评估项目。使用回归策略对“社区出院”PACQI 进行建模作为因变量，以确定如何将七个候选 PACQI 的子集组合在一起，纳入一个汇总量表。最后，探讨了整个设施的汇总量表（PACQI 汇总量表）的分布特性。
风险调整后的 PACQI 包括改善状况的指标，包括早期、中期和晚期功能表现的衡量标准，以及行走和临床状况变化的衡量标准以及总体功能综合量表。许多患者（但不是所有患者）在从基线到随访时表现出改善。然而，在 SNF 之间，总结 QI 得分存在很大的州际差异。
该套 PACQI 由五个功能、两个出院和八个临床指标以及一个汇总量表组成。所有 QIs 都可以从多个 interRAI 评估工具中得出，包括 MDS 2.0、interRAI-LTCF、MDS 3.0 和 interRAI-PAC-Rehab。这些措施适合在美国内外广泛分布，允许比较和讨论与更好结果相关的实践。
