改善 HIV 感染者老龄化人群的照护:一种协作式质量改进方法。
Improving Care for People Aging with HIV: A Collaborative Quality Improvement Approach.
机构信息
New York State Department of Health AIDS Institute, Albany, NY, USA.
Albany Damien Center, Albany, NY, USA.
出版信息
J Community Health. 2024 Dec;49(6):1026-1032. doi: 10.1007/s10900-024-01362-5. Epub 2024 Apr 26.
Nearly 60% of people with HIV in New York State are over 50 years of age. After town halls and a statewide survey of long-term survivors, older people living with HIV, and their providers, the Quality of Care Program of the AIDS Institute in the New York State Department of Health developed a statewide quality improvement project that aimed to improve screening for functional impairments among people aging with HIV. Thirteen sites reported outcomes of a pilot project using a modification of the World Health Organization's Integrated Care of Older People (ICOPE) intrinsic capacity screen in small scale, short cycle tests of change. A total of 1,629 people were found to be eligible for screening, and of these, 638 people were screened. Both clinical and non-clinical sites were able to identify significant areas of need. Positive screens ranged from a low of 17% for the identification of hearing issues to 49% for vision concerns. Only 11% of people with memory or nutritional concerns were referred for services; hearing loss was the domain with the largest number of referrals, at 27%. Although in many cases, when referrals were not made, patients/clients were already under care for the identified functional deficit, in other cases no services were available for referral or patients/clients declined to use the offered service. Sites also responded to the findings of the screen by initiating process changes, and many reported continuing to screen for functional impairments after the close of the pilot. The modified ICOPE screen is still in use in sites throughout the state. This pilot demonstrated that a collaboration between people with lived HIV experience, the New York State Department of Health, clinicians, and service providers could result in improved quality of care for people aging with HIV.
纽约州近 60%的艾滋病毒感染者年龄在 50 岁以上。在举办了市政厅会议和对长期幸存者、老年艾滋病毒感染者及其提供者进行全州调查之后,纽约州卫生部艾滋病研究所的护理质量计划制定了一个全州范围的质量改进项目,旨在改善艾滋病毒感染者老龄化人群的功能障碍筛查。13 个地点报告了使用世界卫生组织老年人综合关怀(ICOPE)内在能力筛查的修改版在小规模、短周期的变革测试中进行试点项目的结果。共有 1629 人符合筛查条件,其中 638 人接受了筛查。临床和非临床站点都能够确定有重大需求的领域。阳性筛查结果从发现听力问题的 17%到视力问题的 49%不等。只有 11%的记忆力或营养问题患者/客户被推荐接受服务;听力损失是转诊人数最多的领域,为 27%。尽管在许多情况下,当没有进行转诊时,患者/客户已经在接受所确定的功能缺陷的治疗,但在其他情况下,没有可供转诊的服务,或者患者/客户拒绝使用所提供的服务。各站点还根据筛查结果做出了流程改变,许多站点报告在试点结束后继续对功能障碍进行筛查。修改后的 ICOPE 筛查仍在全州范围内的各站点使用。该试点表明,艾滋病毒感染者、纽约州卫生部、临床医生和服务提供者之间的合作可以改善老年艾滋病毒感染者的护理质量。