Fassbender Konrad, Biondo Patricia, Holroyd-Leduc Jayna, Potapov Alexei, Wityk Martin Tracy Lynn, Wasylenko Eric, Hagen Neil Angus, Simon Jessica
Department of Oncology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
BMJ Support Palliat Care. 2021 Feb 12. doi: 10.1136/bmjspcare-2020-002780.
In 2014, the province of Alberta, Canada implemented a province-wide policy and procedures for advance care planning (ACP) and goals of care designation (GCD) across its complex, integrated public healthcare system. This study was conducted to identify and operationalise performance indicators for ACP/GCD to monitor policy implementation success and sustainment of ACP/GCD practice change.
A systematic review and environmental scan was conducted to identify potential indicators of ACP/GCD uptake (n=132). A purposive sample of ACP/GCD stakeholders was invited to participate in a modified Delphi study to evaluate, reduce and refine these indicators through a combination of face-to-face meetings and online surveys.
An evidence-informed Donabedian by Institute of Medicine (IOM) framework was adopted as an organising matrix for the indicators in an initial face-to-face meeting. Three online survey rounds reduced and refined the 132 indicators to 18. A final face-to-face meeting operationalised the indicators into a measurable format. Nine indicators, covering 11 of the 18 Donabedian×IOM domains, were operationalised.
Nine ACP/GCD evidence-informed indicators mapping to 11 of 18 Donabedian×IOM domains were endorsed, and have been operationalised into an online ACP/GCD dashboard. The indicators provide a characterisation of ACP/GCD uptake that could be generalised to other healthcare settings, measuring aspects related to ACP/GCD documentation, patient satisfaction and agreement between medical orders and care received. The final nine indicators reflect the stakeholders' expressed intent to strike a balance between comprehensiveness and feasibility within a large provincial healthcare system.
2014年，加拿大艾伯塔省在其复杂的综合性公共医疗系统中实施了一项全省范围的预先护理计划（ACP）和护理目标指定（GCD）政策及程序。本研究旨在确定并实施ACP/GCD的绩效指标，以监测政策实施的成功情况以及ACP/GCD实践变革的持续性。
进行了系统综述和环境扫描，以确定ACP/GCD采用情况的潜在指标（n = 132）。邀请了ACP/GCD利益相关者的目的样本参与一项经过修改的德尔菲研究，通过面对面会议和在线调查相结合的方式来评估、减少和完善这些指标。
在最初的面对面会议上，采用了医学研究所（IOM）基于证据的唐纳贝迪安框架作为指标的组织矩阵。三轮在线调查将132个指标减少并完善为18个。最后一次面对面会议将这些指标转化为可衡量的形式。九个指标得以实施，涵盖了18个唐纳贝迪安×IOM领域中的11个。
认可了九个与18个唐纳贝迪安×IOM领域中的11个相对应的基于证据的ACP/GCD指标，并已将其转化为在线ACP/GCD仪表板。这些指标对ACP/GCD的采用情况进行了描述，可推广到其他医疗环境，衡量与ACP/GCD文件记录、患者满意度以及医疗医嘱与所接受护理之间的一致性相关的方面。最终的九个指标反映了利益相关者在大型省级医疗系统中寻求在全面性和可行性之间取得平衡的明确意图。
