School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Clinical Design and Innovation, Health Service Executive, National Clinical Programme for Older People, Dublin, Ireland.
BMC Emerg Med. 2023 Oct 20;23(1):123. doi: 10.1186/s12873-023-00893-9.
Innovations in models of care for older adults living with frailty presenting to the emergency department (ED) have become a key priority for clinicians, researchers and policymakers due to the deleterious outcomes older adults experience due to prolonged exposure to such an environment. This study aimed to develop a set of expert consensus-based statements underpinning operational design, outcome measurement and evaluation of a Frailty at the Front Door (FFD) model of care for older adults within an Irish context.
A modified real-time Delphi method was used. Facilitation of World Café focus groups with an expert panel of 86 members and seperate advisory groups with a Public and Patient Involvement panel of older adults and members of the Irish Association of Emergency Medicine generated a series of statements on the core elements of the FFD model of care. Statements were analysed thematically and incorporated into a real-time Delphi survey, which was emailed to members of the expert panel. Members were asked to rank 70 statements across nine domains using a 9-point Likert scale. Consensus criteria were defined a priori and guided by previous research using 9-point rating scales.
Fifty members responded to the survey representing an overall response rate of 58%. Following analyses of the survey responses, the research team reviewed statements for content overlap and refined a final list of statements across the following domains: aims and objectives of the FFD model of care; target population; screening and assessment; interventions; technology; integration of care; evaluation and metrics; and research.
Development of a consensus derived FFD model of care represents an important step in generating national standards, implementation of a service model as intended and enhances opportunities for scientific impact. Future research should focus on the development of a core outcome set for studies involving older adults in the ED.
由于老年人在急诊科（ED）中长时间暴露于这种环境中，会导致不良后果，因此，创新老年人脆弱模型的护理模式已成为临床医生、研究人员和政策制定者的主要重点。本研究旨在制定一套基于专家共识的陈述，为爱尔兰背景下的老年人脆弱性前门（FFD）护理模式的操作设计、结果测量和评估提供依据。
采用改良实时 Delphi 方法。通过 86 名专家小组的世界咖啡馆焦点小组讨论和公共与患者参与小组的单独咨询小组，与老年人和爱尔兰急诊医学协会成员一起，生成了一系列关于 FFD 护理模式核心要素的陈述。对陈述进行主题分析，并将其纳入实时 Delphi 调查，该调查通过电子邮件发送给专家小组的成员。成员被要求使用 9 分李克特量表对 9 个领域的 70 个陈述进行排名。共识标准是根据之前使用 9 分评分量表的研究预先定义的。
50 名成员对调查做出了回应，总体回应率为 58%。在对调查结果进行分析后，研究小组对陈述的内容重叠进行了审查，并在以下领域中列出了最终的陈述清单：FFD 护理模式的目标和目的；目标人群；筛选和评估；干预措施；技术；护理整合；评估和指标；以及研究。
制定共识驱动的 FFD 护理模式代表了制定国家标准、按预期实施服务模式以及增强科学影响力的重要步骤。未来的研究应集中在为涉及急诊科老年人的研究制定核心结局集。
