老年人急性护理中衰弱患者报告结局测量工具（PROM-OPAC）：现场测试和验证。

The patient-reported outcome measure for older people living with frailty receiving acute care (PROM-OPAC): field-testing and validation.

机构信息

Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, United Kingdom.

College of Life Sciences, George Davies Centre, University of Leicester, Leicester, UK.

出版信息

J Patient Rep Outcomes. 2024 Oct 16;8(1):119. doi: 10.1186/s41687-024-00796-8.

DOI:10.1186/s41687-024-00796-8

PMID:39414637

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11484973/

Abstract

BACKGROUND

Current acute healthcare service metrics are not meaningful for older people living with frailty. Healthcare knowledge, situational security, and physical and psychosocial function are important outcomes typically not collected. The use of patient-reported outcome measures (PROMs) could support these assessments. Existing instruments are not comprehensive as they typically consider function, while older people with frailty also value enablement (self-determination and security in health and healthcare). This study field-tested and validated a PROM for older people with frailty receiving acute care (PROM-OPAC) to measure enablement.

METHODS

People aged 65+ with Clinical Frailty Scale 5-8 were recruited within seventy-two hours of an emergency attendance. Iterations of the novel instrument were administered over three stages: (1) preliminary field-testing for reliability (response distribution and internal consistency) and structure (exploratory factor analysis, EFA); (2) intermediate field-testing of an improved instrument for reliability and structure; (3) final draft validation assessing reliability, structure (confirmatory factor analysis, CFA), and construct validity based on a priori hypotheses. Feasibility was appraised throughout using data completeness and response rates and times.

RESULTS

241 people participated. Three items of a preliminary seven-item measure had poor response distribution or loading and were accordingly improved. The intermediate instrument had interpretability issues and three items required further improvement. The final eight-item draft had acceptable reliability (Cronbach's alpha: 0.71), structure (two factors for self-determination and security; RMSEA: 0.065; TLI: 0.917; CFI: 0.944), and construct validity (lower scores from respondents waiting longer and requiring admission). Feasibility was promising (response rate 39%; 98% responses complete; median completion time 11 (IQR: 12) minutes).

CONCLUSIONS

Administration of the PROM-OPAC appeared feasible and the instrument had acceptable psychometric properties. Further evaluation is required to assess generalisability.

摘要

背景

当前的急性医疗保健服务指标对患有衰弱症的老年人来说没有意义。医疗知识、情境安全以及身体和心理社会功能是通常未收集的重要结果。使用患者报告的结果测量（PROM）可以支持这些评估。现有的工具并不全面，因为它们通常考虑功能，而患有衰弱症的老年人也重视赋权（健康和医疗保健方面的自我决定和安全）。本研究现场测试和验证了一种用于接受急性护理的衰弱老年人的 PROM（PROM-OPAC），以衡量赋权。

方法

在急诊就诊后 72 小时内招募年龄在 65 岁及以上且临床虚弱量表评分为 5-8 的人群。该新型仪器经过三个阶段进行迭代：（1）初步现场测试以评估可靠性（响应分布和内部一致性）和结构（探索性因素分析，EFA）；（2）中间阶段对经过改进的仪器进行可靠性和结构测试；（3）最终草案验证，根据先验假设评估可靠性、结构（验证性因素分析，CFA）和结构效度。通过数据完整性和响应率和时间来评估整个可行性。

结果

共有 241 人参与。初步的七项措施中有三项的响应分布或加载效果较差，因此进行了改进。中间仪器存在可解释性问题，需要进一步改进三项措施。最终的八项草案具有可接受的可靠性（Cronbach's alpha：0.71）、结构（自我决定和安全的两个因素；RMSEA：0.065；TLI：0.917；CFI：0.944）和结构效度（等待时间较长和需要入院的受访者得分较低）。可行性很有希望（响应率 39%；98%的回复完整；中位数完成时间为 11（IQR：12）分钟）。