Lepore Michael, Zúñiga Franziska, Schols Jos M G A, Wingenfeld Klaus, van Achterberg Theo, Murray Briana
University of Maryland School of Nursing, Baltimore, MD, USA.
University of Basel, Nursing Science, Basel, Switzerland.
J Am Med Dir Assoc. 2023 May;24(5):729-734. doi: 10.1016/j.jamda.2023.02.107. Epub 2023 Mar 25.
Alzheimer's disease and related dementias (ADRD) are prevalent conditions in long-term care homes (LTCHs) with most LTCH residents living with ADRD in many countries. Despite the prevalence of ADRD in LTCHs, a recent examination of LTCH quality measurement programs in 4 countries revealed few LTCH quality measures addressed ADRD, most commonly as a risk adjuster. We sought to better understand how quality measurement programs address ADRD internationally.
International comparative analysis.
We examined LTCH quality measures in 4 European countries-Germany, Switzerland, Belgium, and the Netherlands.
The specifications to calculate each measure were assessed to determine whether the measure was calculated without assessing for ADRD, included only residents with ADRD, excluded residents with ADRD, or was risk adjusted for the presence of ADRD among the LTCH residents.
A total of 143 measures were examined across 4 quality measurement programs. Thirty-seven percent of the measures explicitly address ADRD. The programs addressed ADRD in starkly different ways. In Germany, most (13 of 15) measures addressed ADRD, and did so as an exclusion or inclusion criterion, and in Switzerland all the measures addressed ADRD through risk adjustment. In Flanders, Belgium, all measures were calculated without assessing for ADRD. In the Netherlands, one-third of the measures explicitly addressed ADRD by restricting the measure to psychogeriatric units.
Although limited to examining measures from LTCH quality measurement programs in 4 European countries, this study adds evidence that ADRD tends not to be addressed by LTCH quality measures, but when ADRD is addressed, it tends to be through inclusion or exclusion criteria. LTCH regulators, policymakers, and providers can use this information to assess options for addressing ADRD in quality measurement programs. Future research is needed to assess how standard indicators of ADRD care quality differ across quality measurement programs.
阿尔茨海默病及相关痴呆症（ADRD）在长期护理机构（LTCH）中很常见，在许多国家，大多数LTCH居民都患有ADRD。尽管ADRD在LTCH中普遍存在，但最近对4个国家的LTCH质量评估项目进行的一项调查显示，很少有LTCH质量评估指标涉及ADRD，最常见的是作为风险调整因素。我们试图更好地了解国际上质量评估项目是如何处理ADRD的。
国际比较分析。
我们研究了4个欧洲国家（德国、瑞士、比利时和荷兰）的LTCH质量评估指标。
评估计算每个指标的规范，以确定该指标是在未评估ADRD的情况下计算的，仅包括患有ADRD的居民，排除患有ADRD的居民，还是针对LTCH居民中ADRD的存在进行了风险调整。
在4个质量评估项目中，共检查了143个指标。37%的指标明确涉及ADRD。这些项目处理ADRD的方式截然不同。在德国，大多数（15个中的13个）指标涉及ADRD，并将其作为排除或纳入标准；在瑞士，所有指标都通过风险调整来处理ADRD。在比利时的弗拉芒地区，所有指标都是在未评估ADRD的情况下计算的。在荷兰，三分之一的指标通过将指标限制在老年精神科病房来明确涉及ADRD。
尽管本研究仅限于检查4个欧洲国家LTCH质量评估项目的指标，但它补充了证据，表明LTCH质量指标往往不涉及ADRD，但当涉及ADRD时，往往是通过纳入或排除标准。LTCH监管机构、政策制定者和提供者可以利用这些信息来评估在质量评估项目中处理ADRD的选项。未来需要进行研究，以评估不同质量评估项目中ADRD护理质量的标准指标有何差异。
