痴呆患者初级保健质量指标框架。
Quality indicator framework for primary care of patients with dementia.
机构信息
Assistant Professor in the Department of Management, Evaluation and Health Policy at the School of Public Health at the University of Montréal in Quebec.
Assistant Professor in the Division of Geriatric Medicine at McGill University in Montréal.
出版信息
Can Fam Physician. 2022 Sep;68(9):e270-e278. doi: 10.46747/cfp.6809e270.
OBJECTIVE
To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators.
DESIGN
Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was carried out through a stakeholder survey.
SETTING
Ontario, Quebec, New Brunswick, and Saskatchewan.
PARTICIPANTS
Stakeholders in community dementia care (N=109) including clinicians, patients, caregivers, decision makers, and managers.
MAIN OUTCOME MEASURES
Primary care quality indicators.
RESULTS
The framework comprised 34 indicators across 8 domains of quality (access, integration, effective care, efficient care, equity, safety, population health, and patient-centred care). Access to a regular primary care provider, continuity of care, early-stage diagnosis, and access to home care were consistently rated as priorities. Equitable care was a specific priority among patients and caregivers; clinicians reported avoidable hospitalizations as among their priorities.
CONCLUSION
A framework of indicators was established for persons with dementia that adds an important dimension to existing primary care and dementia quality indicators by providing primary care and population-based perspectives. This framework could set a foundation for the ongoing monitoring of primary care practices and policies for persons with dementia at a population level.
目的
制定一个基于人群的初级保健质量指标框架,以适应痴呆症患者,并确定一组由利益相关者驱动的优先指标。
设计
通过选择基于快速审查和确定相关指标的初始框架,并基于现有痴呆症指标和指南进行充实,来开展框架的制定工作。通过利益相关者调查对指标进行优先级排序。
地点
安大略省、魁北克省、新不伦瑞克省和萨斯喀彻温省。
参与者
包括临床医生、患者、护理人员、决策者和管理人员在内的社区痴呆症护理利益相关者(N=109)。
主要观察指标
初级保健质量指标。
结果
该框架包括 8 个质量领域(可及性、整合性、有效护理、高效护理、公平性、安全性、人群健康和以患者为中心的护理)的 34 个指标。定期获得初级保健提供者的服务、护理的连续性、早期诊断和获得家庭护理被一致认为是优先事项。公平的护理是患者和护理人员的一个具体优先事项;临床医生报告说,可避免的住院治疗是他们的优先事项之一。
结论
为痴呆症患者制定了一个指标框架,通过提供初级保健和基于人群的视角,为现有的初级保健和痴呆症质量指标增加了一个重要维度。该框架可以为在人群层面上对痴呆症患者的初级保健实践和政策进行持续监测奠定基础。