New England GRECC, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Open Qual. 2021 Jan;10(1). doi: 10.1136/bmjoq-2020-001140.
Frailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into an outpatient preventive cardiology clinic.
Quality improvement (QI) project initiated at VA Boston in January 2015 to measure usual gait speed in m/s over a 4 m distance for patients aged 70 and older. The primary outcome was completion and documentation of 4 m usual gait speed. Data were manually extracted from the electronic health record. Frequency distributions and descriptive statistics are presented.
Several change interventions were implemented over a 5-year period (January 2015-December 2019) addressing (1) stakeholder engagement and project champions, (2) staff education, (3) assessment space, (4) electronic health record template update and (5) sustaining the initiative. Statistical process control charts were used to monitor proportion of gait speed measurement and to detect shifts resulting from 5 phase change interventions.
During this QI project, 178 patients aged 70 and older attended the clinic, accounting for 1042 individual clinic visits. Gait speed was measured at least once for 157 patients; 21 were never assessed. At the end of the first month (January 2015), gait speed was measured during 40% of clinic visits and rose to a median measurement rate of 78% at clinic visits during the 2018-2019 study period. An unanticipated result was the spread of the initiative to other cardiology clinics.
Gait speed measurement was successfully embedded into clinic assessments for older adults at a cardiology clinic following targeted interventions. This project highlights the feasibility of incorporating a brief frailty assessment such as gait speed, into non-geriatric medicine clinics.
在评估患有心血管疾病的老年人时，建议进行虚弱测量，以实现个体化的预防和治疗。我们试图通过将临床医生常规的步态速度测量纳入门诊预防心脏病学诊所来实现这一目标。
2015 年 1 月，VA 波士顿启动了一项质量改进（QI）项目，以测量 70 岁及以上患者在 4 米距离内的常规步态速度，单位为米/秒。主要结果是完成并记录 4 米常规步态速度。数据从电子健康记录中手动提取。呈现了频率分布和描述性统计数据。
在 5 年期间（2015 年 1 月至 2019 年 12 月）实施了几项变更干预措施，包括（1）利益相关者参与和项目负责人，（2）员工教育，（3）评估空间，（4）电子健康记录模板更新和（5）维持倡议。统计过程控制图用于监测步态速度测量的比例，并检测 5 个阶段变更干预措施导致的变化。
在这个 QI 项目中，178 名 70 岁及以上的患者参加了诊所，共进行了 1042 次单独的诊所就诊。至少对 157 名患者进行了一次步态速度测量；21 名患者从未接受过评估。在第一个月（2015 年 1 月）结束时，40%的诊所就诊时测量了步态速度，在 2018 年至 2019 年的研究期间，诊所就诊时的中位数测量率上升至 78%。一个意外的结果是该倡议扩展到其他心脏病学诊所。
在心脏病学诊所，通过有针对性的干预措施，成功地将步态速度测量纳入了对老年人的临床评估中。该项目强调了将简单的虚弱评估（如步态速度）纳入非老年医学诊所的可行性。
