创伤医护人员对衰弱评估的认知：一项关于知识、态度和信念的混合方法分析

Trauma Providers' Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs.

作者信息

Shoultz Thomas H, Moore Megan, Reed May J, Kaplan Stephen J, Bentov Itay, Hough Catherine, Taitsman Lisa A, Mitchell Steven H, So Grace E, Arbabi Saman, Phelan Herb, Pham Tam

机构信息

From the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, the School of Social Work, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, the Department of Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington, the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, the Department of Orthopedics and Sports Medicine, University of Washington, Seattle, the Department of Emergency Medicine, University of Washington, Seattle, the Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, the Department of Surgery, Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and the Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, University of Washington, Seattle, Washington.

出版信息

South Med J. 2019 Mar;112(3):159-163. doi: 10.14423/SMJ.0000000000000948.

DOI:10.14423/SMJ.0000000000000948

PMID:30830229

Abstract

OBJECTIVES

Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers' knowledge and beliefs about frailty assessment. This study sought to understand trauma providers' understanding, beliefs, and practices for frailty assessment.

METHODS

We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors. Results were analyzed via mixed methods.

RESULTS

One hundred fifty-one providers completed the survey (response rate 92%). Respondents commonly included calendar age as an integral factor in their determinations of frailty but also included a variety of other factors, highlighting limited definitional consensus. Respondents perceived frailty as important to older adult patient outcomes, but assessment techniques were varied because only 24/151 respondents (16%) were familiar with current formal frailty assessment tools. Perceived barriers to performing a formal frailty screening on all injured older adults included the burdensome nature of assessment tools, insufficient training, and lack of time. When prompted for solutions, 20% of respondents recommended automation of the screening process by trained, dedicated team members.

CONCLUSIONS

Providers seem to recognize the impact that a diagnosis of frailty has on outcomes, but most lack a working knowledge of how to assess for frailty syndrome. Some providers recommended screening by designated, formally trained personnel who could notify decision makers of a positive screen result.

摘要

目的

老年创伤的质量改进取决于对虚弱的及时识别，但对于医疗服务提供者关于虚弱评估的知识和信念了解甚少。本研究旨在了解创伤医疗服务提供者对虚弱评估的理解、信念和实践。

方法

我们使用健康行为的健康信念模型开发了一份包含20个问题的调查问卷，并对一家未对所有受伤老年人进行正式虚弱筛查的单一机构的创伤服务部门的医生、高级执业提供者和实习生进行了调查。通过混合方法对结果进行分析。

结果

151名提供者完成了调查（回复率92%）。受访者通常将日历年龄作为其虚弱判定中的一个重要因素，但也包括各种其他因素，这突出了定义上的有限共识。受访者认为虚弱对老年患者的预后很重要，但评估技术各不相同，因为只有24/151名受访者（16%）熟悉当前的正式虚弱评估工具。对所有受伤老年人进行正式虚弱筛查的感知障碍包括评估工具繁琐、培训不足和时间不足。当被问及解决方案时，20%的受访者建议由训练有素的专门团队成员对筛查过程进行自动化。