Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open Qual. 2022 Mar;11(1). doi: 10.1136/bmjoq-2021-001639.
Long-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset.
In the Older Persons' Transitions in Care (OPTIC) study, we collected information on residents' transitions in two Western Canadian cities. We applied the IOM's Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality.
We tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to develop measures for equitable care at an individual transfer level. Domain scores varied across individual transitions, with the highest scores in safety (MED 79%, IQR: 63-95), efficiency (66%; IQR: 66-99), and resident-centred (45%; IQR: 25-65), followed by effectiveness (36%; IQR: 16-56), and timeliness (0%; IQR: 0-50).
Our results show variation in scores across the domains of quality suggesting that it is possible to track quality of transitions for individuals across all settings, and not only within settings. We recommend that future work in tracking quality of care be performed at several levels (LTC, region, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.
长期护理（LTC）居民经常在更高级别的护理提供地点发生转变，包括接受急诊部（ED）护理。在这项概念验证研究中，我们旨在确定是否可以通过将医疗保健研究所（IOM）的护理质量领域应用于现有数据集，来识别从 LTC 到 ED 并通过紧急医疗服务返回的过渡过程中的护理质量措施。
在老年人护理过渡研究（OPTIC）中，我们在加拿大西部的两个城市收集了居民过渡信息。我们将 IOM 的护理质量领域应用于 OPTIC 数据，以创建过渡质量的二进制措施。我们报告了每个质量领域中满足的措施的中位数（MED）百分比和 IQR。
在 12 个月的时间里，我们跟踪了 637 次过渡，每个设置都收集了数据。我们制定了 19 项安全措施、20 项以居民为中心的护理措施、3 项及时护理措施和 5 项有效护理措施。我们无法在个人转院层面制定公平护理的措施。各个过渡的领域评分存在差异，安全性评分最高（MED79%，IQR：63-95），效率（66%，IQR：66-99）和以居民为中心（45%，IQR：25-65），其次是有效性（36%，IQR：16-56）和及时性（0%，IQR：0-50）。
我们的结果表明，质量领域的评分存在差异，这表明有可能在所有设置中跟踪个人过渡的质量，而不仅仅是在设置内。我们建议在跟踪护理质量方面开展未来工作应在多个层面（LTC、地区、卫生当局、省）进行。这种跟踪对于评估和提高整体护理质量是必要的。
