决策支持系统（DSS）对市政护士评估老年人健康恶化的心理测量学评价。

Psychometric evaluation of the Decision Support System (DSS) for municipal nurses encountering health deterioration among older adults.

机构信息

School of Health Sciences, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.

Older Adults' Health and Living Condition, Örebro University, Örebro, Sweden.

出版信息

BMC Geriatr. 2024 Mar 26;24(1):283. doi: 10.1186/s12877-024-04903-8.

DOI:10.1186/s12877-024-04903-8

PMID:38528517

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10964528/

Abstract

BACKGROUND

A valid and reliable tool is crucial for municipal registered nurses (RNs) to make quick decisions in older adults who show rapid signs of health deterioration. The aim of this study was to investigate the psychometric properties of the Decision Support System (DSS) among older adults in the municipal healthcare system.

METHODS

Firstly, we utilized the Rasch dichotomous model to analyze the DSS assessments (n=281) that were collected from municipal RNs working with older adults in the municipal healthcare system. We examined the properties of the DSS in terms of its unidimensionality, item fit, and separation indices. Secondly, to investigate inter-rater agreement in using the DSS, four experienced municipal RNs used the DSS to assess 60 health deterioration scenarios presented by one human patient simulators. The 60 DSS assessments were then analyzed using the ICC (2,1), percentage agreement, and Cohen κ statistics.

RESULTS

The sample of older adults had a mean age of 82.8 (SD 11.7). The DSS met the criteria for unidimensionality, although two items did not meet the item fit statistics when all the DSS items were analyzed together. The person separation index was 0.47, indicating a limited level of separation among the sample. The item separation index was 11.43, suggesting that the DSS has good ability to discriminate between and separate the items. At the overall DSS level, inter-rater agreements were good according to the ICC. At the individual DSS item level, the percentage agreements were 75% or above, while the Cohen κ statistics ranged from 0.46 to 1.00.

CONCLUSIONS

The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although further research with a larger sample size and more items is needed. The DSS has the potential to assist municipal RNs in making clinical decisions regarding health deterioration in older adults, thereby avoiding unnecessary emergency admistion and helping.

摘要

背景

对于在老年人中迅速出现健康恶化迹象的情况下做出快速决策的市级注册护士（RN）来说，一个有效的、可靠的工具是至关重要的。本研究旨在调查决策支持系统（DSS）在市级医疗保健系统中的老年人中的心理测量学特性。

方法

首先，我们利用二分 Rasch 模型对从市级医疗保健系统中为老年人工作的市级注册护士收集的 281 份 DSS 评估进行分析。我们从单维性、项目拟合和分离指数三个方面研究了 DSS 的特性。其次，为了研究使用 DSS 的评分者间一致性，四位有经验的市级注册护士使用 DSS 对一名人工患者模拟器呈现的 60 个健康恶化情景进行评估。然后，使用 ICC（2,1）、百分比一致性和 Cohen κ 统计量对这 60 次 DSS 评估进行分析。

结果

老年人样本的平均年龄为 82.8（SD 11.7）岁。DSS 符合单维性标准，尽管当所有 DSS 项目一起分析时，有两个项目不符合项目拟合统计量。人的分离指数为 0.47，表明样本之间的分离程度有限。项目分离指数为 11.43，表明 DSS 具有良好的区分和分离项目的能力。在 DSS 整体水平上，根据 ICC，评分者间一致性良好。在个别 DSS 项目水平上，百分比一致性在 75%或以上，而 Cohen κ 统计量范围在 0.46 至 1.00。