Division Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Medical University Vienna, A-1090, Vienna, Austria.
Department of Health Economics, Center for Public Health, Medical University Vienna, A-1090, Vienna, Austria.
Clin Nutr. 2020 Jun;39(6):1667-1680. doi: 10.1016/j.clnu.2019.07.025. Epub 2019 Aug 7.
Quality indicators (QIs) can be used to assess and improve the quality of care in health care institutions. Although QIs about nutrition care in hospitals and nursing homes have been used in studies, no systematic catalogue exists to date. This systematic literature review identifies nutrition care QIs in hospitals and nursing homes and maps them according to QI type, stakeholder level and nutrition care theme. We also assess the level of consensus between studies and critically appraise the QIs presented therein based on two conceptual frameworks.
Ovid, Scopus and grey literature were searched from 1995 to 2016 including studies in English and German. Papers were considered if they presented, developed, assessed, rated or applied nutrition care QIs in hospitals or nursing homes. We used Donabedian's framework to define structure, process and outcome indicators, the WHO (World Health Organization) definition to describe stakeholder levels, and a structured table to map indicators within themes. Further, we used the Institute of Medicine (IOM) and the Organisation for Economic Cooperation and Development (OECD) frameworks' key dimensions to measure the conceptual quality of the QIs. Results are summarised and presented tabulated and narratively.
From 536 identified studies, 46 were included. Eight hundred and twenty-two QIs were extracted and mapped into 19 themes and 151 sub-themes. Half were process indicators (49%) and about a quarter were outcome (28%) and structure (23%) indicators, respectively. The vast majority (71%) targeted micro level, while 28% meso level and only 1% macro level information. The nutrition themes meals/mealtimes (12%), treatment (adherence) (12%), nutrition screening (7%), assessment (7%) and monitoring (7%) were most frequently covered. 69% of indicators were cited by more than one study. Most frequent framework dimensions were patient-centeredness (33%), timeliness (30%), validity (30%) and actionability/feasibility (30%).
The large number of nutrition care QIs in hospitals and nursing homes indicates the high interest in and importance of better nutrition care provision in institutions. However, the great variability indicates little consensus of the nutrition community on how to best assess and measure the quality of nutrition care. The limited methodological and conceptual validity of presented QIs and the low representation of QIs at macro and meso levels make international consensus finding complicated. Increased efforts including all stakeholder levels and using conceptual frameworks to define a limited number of key QIs with high methodological validity, actionability and stakeholder relevance are needed. Registration in clinicaltrials.gov: Identifier: NCT02820246.
质量指标（QIs）可用于评估和改善医疗机构的医疗质量。虽然已有研究中使用了有关医院和疗养院营养护理的 QI，但目前尚无系统目录。本系统文献综述确定了医院和疗养院的营养护理 QI，并根据 QI 类型、利益相关者级别和营养护理主题对其进行了映射。我们还根据两个概念框架评估了研究之间的共识程度，并根据两个概念框架对其中提出的 QI 进行了批判性评估。
从 1995 年到 2016 年，我们在 Ovid、Scopus 和灰色文献中进行了搜索，包括英语和德语的研究。如果论文提出、制定、评估、评级或应用了医院或疗养院的营养护理 QI，则将其视为符合条件。我们使用 Donabedian 的框架来定义结构、过程和结果指标，使用世界卫生组织（WHO）的定义来描述利益相关者级别，并使用结构化表格在主题内映射指标。此外，我们还使用了美国医学研究所（IOM）和经济合作与发展组织（OECD）框架的关键维度来衡量 QI 的概念质量。结果以表格和叙述的形式进行总结和呈现。
从 536 项已确定的研究中，有 46 项被纳入。共提取了 822 个 QI，并映射到 19 个主题和 151 个子主题中。其中一半是过程指标（49%），约四分之一是结果（28%）和结构（23%）指标。绝大多数（71%）针对微观层面，而 28%针对中观层面，只有 1%针对宏观层面。营养主题包括膳食/用餐时间（12%）、治疗（依从性）（12%）、营养筛查（7%）、评估（7%）和监测（7%）等方面。69%的指标被超过一项研究引用。最常引用的框架维度是以患者为中心（33%）、及时性（30%）、有效性（30%）和可操作性/可行性（30%）。
医院和疗养院中大量的营养护理 QI 表明，人们对改善机构内营养护理服务的兴趣和重视程度很高。然而，这种巨大的差异表明，营养界在如何最好地评估和衡量营养护理质量方面尚未达成共识。提出的 QI 在方法学和概念上的有效性有限，以及宏观和中观层面 QI 的代表性不足，使得国际上达成共识变得复杂。需要加大努力，包括所有利益相关者层面，并使用概念框架来定义具有高方法学有效性、可操作性和利益相关者相关性的少数关键 QI。在 clinicaltrials.gov 中注册：标识符：NCT02820246。
