Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada.
Quebec Excellence Centre on Aging, Quebec, Canada.
BMC Geriatr. 2022 Feb 23;22(1):149. doi: 10.1186/s12877-022-02843-9.
To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population.
In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts.
The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients' quality of life; increasing healthcare staff skills; decreasing patients' symptoms; decreasing family caregiver burden; increasing patients' satisfaction with care; and increasing family doctor continuity of care.
Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.
为了更好地满足衰弱老年人的需求，了解从他们的角度来看哪些护理方面是重要的至关重要。因此，我们试图评估一套质量指标（QI）在监测该人群结果方面的重要性。
在这项混合方法研究中，利益攸关方通过调查对 36 个 QI 的重要性进行了评估，然后在半结构化访谈中对其评分进行了解释。利益攸关方包括衰弱的老年人及其照顾者、医疗保健提供者（HCP）以及医疗保健管理人员或政策/决策者（DM）。我们对定量变量进行了描述性统计分析，并对访谈记录进行了演绎主题定性分析。
42 名参与者（8 名老年人、18 名 HCP 和 16 名 DM）将 6 个 QI 评为更重要：提高患者的生活质量；提高医护人员的技能；减少患者的症状；减轻家庭照顾者的负担；提高患者对护理的满意度；增加家庭医生的护理连续性。
主要利益攸关方优先考虑侧重于患者和照顾者的结果的 QI，而当前的医疗保健系统通常侧重于护理过程。因此，质量改进举措应更好地考虑到对衰弱老年人重要的护理方面，例如有机会表达他们个人的护理目标、从 HCP 那里获得高质量的沟通，或监测他们可能不会主动描述的症状。我们的研究结果表明，需要以生活质量为导向，为衰弱的老年人提供以患者为中心的护理。
