Veterans Affairs Center for Clinical Management Research, 20034VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Department of Psychiatry, 1259University of Michigan Medical School, Ann Arbor, MI, USA.
J Geriatr Psychiatry Neurol. 2023 Mar;36(2):164-170. doi: 10.1177/08919887221106446. Epub 2022 Jun 2.
We convened a two-round, modified Delphi panel to identify and reach consensus on additional potential quality indicators (QIs) for nursing home residents with dementia.
The study team identified 12 potential QIs for nursing home dementia care and treatment of behavioral disturbances based on review of the literature. All proposed QIs were readily available in administrative claims data. Panelists rated each QI on importance, usefulness, and feasibility (a total of 36 items) using a 9-point Likert scale. Data were collected using an online survey platform and virtual group discussion. We defined consensus as ≥70% of the panelists responding within a three-point range surrounding the median. A QI achieved relevance on a domain (importance, usefulness, feasibility) when the panel reached consensus and a median rating of 7-9.
The study had a 100% response rate for both survey rounds. Twenty-four items achieved consensus, with 15 reaching relevance with a median >7. Three QIs (percent of long-stay residents with dementia prescribed APs, percent with physical restraint use, and percent with a positive behavioral symptom score) reached consensus at the highest median score (9) for importance. Only 2 of the 12 proposed QIs reached relevance on all three domains: percent of long-stay residents with dementia prescribed antipsychotics (APs) and percent prescribed benzodiazepines.
Of the proposed QIs, our panel of dementia care experts only reached consensus on two QIs: measuring long-stay resident prescriptions of APs and benzodiazepines. Challenges remain in identifying QIs that meet threshold of all three areas and accurately reflect quality nursing home dementia care.
我们组织了两轮修改后的德尔菲小组会议，以确定并就额外的潜在质量指标（QIs）达成共识，这些指标适用于患有痴呆症的养老院居民。
研究小组根据文献回顾，确定了 12 项针对养老院痴呆症护理和行为障碍治疗的潜在 QIs。所有提出的 QIs 都可以在行政索赔数据中轻松获得。小组成员使用 9 分 Likert 量表对每项 QI 的重要性、有用性和可行性（共 36 项）进行评分。数据通过在线调查平台和虚拟小组讨论收集。我们将共识定义为在中位数周围的三个点范围内，有≥70%的小组成员做出回应。当小组就某个领域（重要性、有用性、可行性）达成共识且中位数评分为 7-9 时，某项 QI 就具有相关性。
两轮调查的回复率均为 100%。24 项达成共识，其中 15 项的中位数>7，具有相关性。三项 QIs（痴呆长住居民中服用抗精神病药物的百分比、使用身体约束的百分比和行为症状评分阳性的百分比）在重要性方面达到了中位数最高得分（9），达成共识。在所有三个领域均具有相关性的仅为 12 项提议的 QIs 中的两项：痴呆长住居民服用抗精神病药物（APs）和服用苯二氮䓬类药物的百分比。
在提出的 QIs 中，我们的痴呆症护理专家小组仅就两项 QIs 达成共识：衡量长期居住居民的 APs 和苯二氮䓬类药物处方。在确定符合所有三个领域标准并准确反映高质量养老院痴呆症护理的 QIs 方面仍然存在挑战。
