Siette Joyce, Jorgensen Mikaela L, Georgiou Andrew, Dodds Laura, McClean Tom, Westbrook Johanna I
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, 2109, Australia.
Centre for Ageing, Cognition and Wellbeing, Macquarie University, Macquarie Park, New South Wales, 2109, Australia.
BMC Geriatr. 2021 Jun 28;21(1):390. doi: 10.1186/s12877-021-02254-2.
Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets.
A retrospective sample of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients' QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients' electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets.
Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0-1, SD = 0.15). After accounting for other factors, being older (p < 0.01), having lower-level care needs (p < 0.01), receiving services which met needs for assistance with activities of daily living (p < 0.01), and having higher levels of social participation (p < 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% (n = 4) had lower mean risk-adjusted QoL scores than expected (< 95% control limits) and 16% (n = 3) had higher mean scores than expected.
Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support.
Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017.
对于许多护理提供者而言，衡量以患者为中心的结果并利用这些信息来改善服务提供是一项挑战。我们旨在确定接受社区老年护理服务的老年人生活质量的预测因素，并研究不同社区护理服务机构之间的差异。
对1141名年龄≥60岁、在19个服务机构中接受大型服务提供商提供的社区护理服务的澳大利亚人进行回顾性抽样。使用ICEpop CAPability Index获取客户的生活质量。从客户的电子记录中提取生活质量得分和生活质量的预测因素（即社会人口统计学、社会参与和服务使用情况），并使用多变量回归进行分析。使用漏斗图检查各服务机构风险调整后的生活质量得分的差异。
平均年龄为81.5岁（标准差=8），75.5%为女性。客户的生活质量平均得分为0.81（范围0-1，标准差=0.15）。在考虑其他因素后，年龄较大（p<0.01）、护理需求水平较低（p<0.01）、接受满足日常生活活动协助需求的服务（p<0.01）以及社会参与水平较高（p<0.001）与较高的生活质量得分相关。在19个服务机构中，21%（n=4）的风险调整后生活质量平均得分低于预期（<95%控制限），16%（n=3）的平均得分高于预期。
将生活质量作为比较护理质量的指标并进行适当的风险调整可能是可行的。使用生活质量工具使提供者能够衡量和监测其绩效及服务结果，还能识别生活质量较差可能需要额外支持的客户。
澳大利亚和新西兰临床试验注册号：ACTRN12617001212347。于2017年8月18日注册。
