Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada.
PLoS One. 2022 Apr 7;17(4):e0266569. doi: 10.1371/journal.pone.0266569. eCollection 2022.
Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments-an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.
The development efforts took part in multiple stages, between 2017-2021, including a workshop with clinicians and decision-makers working in PC, qualitative interviews with individuals receiving PC, families and decision makers and a modified Delphi panel, based on the RAND/ULCA appropriateness method.
Based on the workshop results, and qualitative interviews, a set of 27 candidate QIs were defined. They capture issues such as caregiver burden, pain, breathlessness, falls, constipation, nausea/vomiting and loneliness. These QIs were further evaluated by clinicians/decision makers working in PC, through the modified Delphi panel, and five were removed from further consideration, resulting in 22 QIs.
Through in-depth and multiple-stakeholder consultations we developed a set of QIs generated with data already collected with interRAI assessments. These indicators provide a feasible basis for quality benchmarking and improvement systems for care providers aiming to optimize PC to individuals and their families.
接受姑息治疗（PC）的个体通常被认为更愿意在家中接受治疗并在家中去世，但很少有研究评估基于家庭和社区的姑息治疗的质量。本项目开发了一组有效的和可靠的质量指标（QIs），这些指标可以使用已经通过 interRAI 评估收集的数据生成，interRAI 评估是一组在北美广泛用于家庭护理客户的国际验证工具。这些 QIs 可以作为决策支持措施，以帮助提供者和决策者为个人及其家庭提供最佳护理。
开发工作分多个阶段进行，时间跨度为 2017 年至 2021 年，包括与从事 PC 的临床医生和决策者的研讨会、接受 PC 的个人、家庭和决策者的定性访谈以及基于 RAND/ULCA 适宜性方法的修改 Delphi 小组。
根据研讨会的结果和定性访谈，确定了一组 27 个候选 QIs。它们涵盖了护理人员负担、疼痛、呼吸困难、跌倒、便秘、恶心/呕吐和孤独等问题。这些 QIs 进一步由从事 PC 的临床医生/决策者通过修改 Delphi 小组进行评估，其中 5 个被排除在进一步考虑之外，最终确定了 22 个 QIs。
通过深入和多利益相关者的协商，我们开发了一组使用已经通过 interRAI 评估收集的数据生成的 QIs。这些指标为旨在为个人及其家庭优化 PC 的护理提供者提供了质量基准和改进系统的可行基础。
