通过图表措施评估基于社区的重病护理计划的护理提供情况。
Evaluating the care provision of a community-based serious-illness care program via chart measures.
机构信息
Department of Family Medicine, University of North Carolina, 590 Manning Drive, CB #7595, Chapel Hill, NC, 27599, USA.
Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA.
出版信息
BMC Geriatr. 2020 Sep 15;20(1):351. doi: 10.1186/s12877-020-01736-z.
BACKGROUND
Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.
METHODS
Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.
RESULTS
Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively).
CONCLUSION
This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.
背景
尽管已经提出了家庭初级保健和姑息治疗计划的质量评估领域，但它们在实践中的应用有限。我们的目的是评估基于社区的严重疾病护理计划中的护理服务提供情况，这是一种结合家庭初级保健和姑息治疗的模式。
方法
对北卡罗来纳州中部的一个基于学术的社区严重疾病护理计划（2014 年 8 月至 2016 年 3 月）中的患者进行回顾性图表审查（n=159）。图表审查包括人口统计学信息、健康状况以及七个质量评估领域的操作化测量：医疗评估、护理协调、安全性、生活质量、提供者能力、目标实现和可及性。
结果
患者主要为女性（56%），平均年龄为 70 岁。患者多病共存（53%有≥3 种合并症），功能受损（45%有≥2 项日常生活活动能力受损），32%有痴呆。在研究期间，31%的患者死亡。图表审查发现，功能状态评估（97%）、跌倒评估（98%）和药物安全评估（96%）的比例很高。疼痛评估（70%）、预先指示讨论（65%）、流感疫苗接种（59%）和抑郁评估（诊断为抑郁症的患者中 54%）的比例较低。认知障碍、精神需求和行为问题评估的频率较低（分别为 35%、22%和 21%）。
结论
这项研究是首次对基于社区的严重疾病护理计划的质量评估措施进行操作化和检验的研究之一，这是一种为脆弱成年人提供的新兴模式。我们的操作化不构成这些措施的验证，并且揭示了需要改进的领域；然而，基于社区的严重疾病护理计划在几个关键的质量评估领域表现良好。需要进一步的工作来验证这些措施。
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