Kaup Migette L, Calkins Margaret P, Davey Adam, Wrublowsky Robert
Department of Interior Design & Fashion Studies, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA.
IDEAS Institute, Cleveland Heights, Ohio, USA.
Innov Aging. 2023 Apr 28;7(5):igad039. doi: 10.1093/geroni/igad039. eCollection 2023.
Current assessment tools for long-term care environments have limited generalizability or ability to be linked to specific quality outcomes. To discriminate between different care models, tools are needed to assess important elements of the environmental design. The goal of this project was to systematically evaluate the reliability and validity of the Environmental Audit Screening Evaluation (EASE) tool to better enable the identification of best models in long-term care design to maintain quality of life for persons with dementia and their caregivers.
Twenty-eight living areas (LAs) were selected from 13 sites similar in organizational/operational commitment to person-centered care but with very different LA designs. LAs were stratified into 3 categories (traditional, hybrid, and household) based primarily on architectural/interior features. Three evaluators rated each LA using the Therapeutic Environment Screening Scale (TESS-NH), Professional Environmental Assessment Protocol (PEAP), Environmental Audit Tool (EAT-HC), and EASE. One of each type of LA was reassessed approximately 1 month after the original assessment.
EASE scores were compared against the scores of 3 existing tools to evaluate its construct validity. The EAT-HC was most closely related to the EASE ( = 0.88). The PEAP and the TESS-NH were less correlated to the EASE ( = 0.82 and 0.71, respectively). Analysis of variance indicated that the EASE distinguished between traditional and home-like settings (0.016), but not hybrid LAs. Interrater and inter-occasion reliability and agreement of the EASE were consistently high.
Neither of the 2 U.S.-based existing environmental assessment tools (PEAP and TESS-NH) discriminated between the 3 models of environments. The EAT-HC was most closely aligned with the EASE and performed similarly in differentiating between the traditional and household models, but the dichotomous scoring of the EAT-HC fails to capture environmental nuances. The EASE tool is comprehensive and accounts for nuanced design differences across settings.
当前用于长期护理环境的评估工具在通用性或与特定质量结果的关联能力方面存在局限。为了区分不同的护理模式，需要工具来评估环境设计的重要要素。本项目的目标是系统评估环境审计筛查评估（EASE）工具的可靠性和有效性，以便更好地识别长期护理设计中的最佳模式，从而维持痴呆症患者及其护理人员的生活质量。
从13个在以人为主的护理方面组织/运营承诺相似但居住区域（LA）设计差异很大的地点选取了28个居住区域。居住区域主要根据建筑/内部特征分为3类（传统型、混合型和家庭型）。三名评估人员使用治疗环境筛查量表（TESS-NH）、专业环境评估协议（PEAP）、环境审计工具（EAT-HC）和EASE对每个居住区域进行评分。每种类型的居住区域中有一个在首次评估后约1个月进行重新评估。
将EASE得分与3种现有工具的得分进行比较，以评估其结构效度。EAT-HC与EASE的相关性最高（=0.88）。PEAP和TESS-NH与EASE的相关性较低（分别为=0.82和0.71）。方差分析表明，EASE能够区分传统型和类似家庭型的环境（P=0.016），但不能区分混合型居住区域。EASE的评分者间信度、不同时间的信度以及一致性一直很高。
美国现有的两种环境评估工具（PEAP和TESS-NH）均无法区分这3种环境模式。EAT-HC与EASE的一致性最高，在区分传统型和家庭型模式方面表现相似，但EAT-HC的二分制评分无法捕捉环境的细微差别。EASE工具全面，考虑到了不同环境下细微的设计差异。
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