Kawase Kiyomi, Igarashi Ayumi, Eltaybani Sameh, Yasaka Taisuke, Sumikawa Yuka, Takaoka Manami, Kashiwabara Kosuke, Fukui Chie, Yamamoto-Mitani Noriko
Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Cancer Information Service Division, Institute for Cancer Control, National Cancer Center, Chuo-ku, Tokyo, Japan.
Geriatr Gerontol Int. 2025 Mar;25(3):442-448. doi: 10.1111/ggi.15074. Epub 2025 Jan 28.
Standardized quality indicators for long-term care (QIs-LTC) were previously developed to ensure high-quality holistic nursing care for older adults. This research aimed to assess the feasibility and reliability of unfavorable health outcomes measured by the QIs-LTC and proposed strategies for improvement.
Thirty-nine pairs of home care nurses assessed 53 clients. We evaluated 20 of the 21 items of feasibility to calculate scores for the "I do not know" answer and test the interrater reliability using bias-adjusted and prevalence-adjusted kappa (PABAK). We then conducted interviews with 16 home care nurses to collect feedback on the implementation of QIs-LTC. Based on this feedback, we developed the QIs-LTC assessment manual and reassessed the QIs-LTC when used with the manual.
The mean for the "I do not know" answer was 13.8%, and the mean PABAK was 0.75 (±0.28). Overall, the reliability was good for physical assessment but inadequate for social aspects. Using the assessment manual, the mean for the "I do not know" answers decreased to 10.4%. The mean PABAK was 0.77 (±0.32) and increased for 12 unfavorable health outcomes.
The feasibility and reliability of most unfavorable health outcomes were ensured by using the newly developed assessment manual. Challenges in education and practice of social aspects were identified. QIs-LTC support individual and agency evaluations, nursing interventions and quality evaluations, which are a priority for long-term care in Japan. Geriatr Gerontol Int 2025; 25: 442-448.
先前已制定长期护理标准化质量指标（QIs-LTC），以确保为老年人提供高质量的整体护理。本研究旨在评估QIs-LTC所衡量的不良健康结局的可行性和可靠性，并提出改进策略。
39对家庭护理护士对53名客户进行了评估。我们对21项可行性项目中的20项进行评估，计算“我不知道”答案的得分，并使用偏差调整和患病率调整kappa（PABAK）检验评分者间信度。然后，我们对16名家庭护理护士进行访谈，收集关于QIs-LTC实施情况的反馈。基于此反馈，我们制定了QIs-LTC评估手册，并在与手册一起使用时重新评估QIs-LTC。
“我不知道”答案的平均比例为13.8%，平均PABAK为0.75（±0.28）。总体而言，身体评估的可靠性良好，但社会方面的可靠性不足。使用评估手册后，“我不知道”答案的平均比例降至10.4%。平均PABAK为0.77（±0.32），12项不良健康结局的信度有所提高。
使用新开发的评估手册可确保大多数不良健康结局的可行性和可靠性。确定了社会方面教育和实践中的挑战。QIs-LTC支持个人和机构评估、护理干预和质量评估，这是日本长期护理的优先事项。《老年医学与老年病学国际杂志》2025年；25：442 - 448。
