Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada.
Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada.
BMC Palliat Care. 2019 Jan 9;18(1):3. doi: 10.1186/s12904-018-0389-y.
Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment.
Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario's geographic regions, and across four common life-limiting illnesses to observe variation.
Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66-2.89) and pain (OR = 1.59; 95% CI: 1.53-1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%).
Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice.
目前，安大略省还没有针对家庭姑息治疗质量的规范化措施。本研究使用标准化评估方法为重病家庭护理患者开发了一套潜在的质量指标。
对 2006 年至 2013 年间完成的安大略省居民家庭护理评估工具（Resident Assessment Instrument for Home Care）的数据进行二次分析，以确定与 65 岁以上重病患者需求相关的质量指标（QIs）。通过文献回顾和姑息治疗领域的专家咨询制定 QIs。严重疾病的定义是预计生存时间不到 6 个月或存在严重健康不稳定。根据安大略省的地理区域和四种常见的绝症对 QIs 的发生率进行分层，以观察变化。
在样本中，14312 名患者被认为患有重病，更有可能经历负面健康结果，如认知表现（OR=2.77；95%CI：2.66-2.89）和疼痛（OR=1.59；95%CI：1.53-1.64）。咨询了 20 位专家，制定了 7 项 QIs。发生率最高的指标是跌倒发生率（50%）、每日疼痛发生率（47%）和照料者困扰发生率（42%）。在区域间，照料者困扰发生率（21.5%）、跌倒发生率（16.6%）和社会隔离发生率（13.7%）的 QI 率差异最大。有某种形式痴呆的患者最有可能出现困扰的照料者（52.6%）或跌倒（53.3%）。
安大略省患有重病的家庭护理患者正经历着高比例的负面健康结果，其中许多结果是可以改变的。RAI-HC 可以作为一种有用的工具，用于识别这些患者，以便更好地了解他们的需求和能力。这些结果为创建和验证一套标准化的 QIs 做出了重要贡献，这些 QIs 可以由使用 RAI-HC 作为常规临床实践一部分的组织生成。
