Rudman D, Bross D, Mattson D E
Department of Medicine, Medical College of Wisconsin, Milwaukee.
J Gen Intern Med. 1994 May;9(5):261-7. doi: 10.1007/BF02599652.
Previous work has shown that clinical indicators reflecting occurrence of bedsores, behavioral disturbances, and deterioration of activities of daily living (ADLs) can be calculated for the long-stay residents of Veterans Affairs (VA) nursing homes from the standard biannual Patient Assessment Instrument (PAI). The present study aimed to construct national curves for these indicators, against which each facility could in the future compare its own values; and to determine the correlations between the indicator values and selected nursing home characteristics.
Eight indicators were calculated for the long-stay (more than six months) residents of the 69 VA nursing homes housing 50 or more such patients from the 1992 PAI data. The indicators were: prevalence of bedsores; incidence of bedsores; prevalence of physically aggressive behavior; incidence of aggressive behavior; and frequencies of six-month losses of eating, mobility, transfer, and toileting functions by the initially independent residents.
There was a two- to sixfold difference between the most favorable quartile and the least favorable quartile for the eight indicators. Significant correlations across institutions were found between the prevalence and incidence of bedsores, the prevalence and incidence of aggressive behavior, and the frequencies of declines in the four ADLs by the initially independent residents. One or several of the indicators were significantly superior in nursing homes with these characteristics: a smaller size, a slower resident turnover rate, a smaller proportion of residents with nonorganic psychoses, a lower ratio of short-stay to long-stay residents, and a lower ratio of independent to dependent long-stay residents.
These data provide national standards against which each VA nursing home can compare its PAI-derived clinical indicator values. The outcomes measured by these indicators appear to be influenced both by casemix and by environmental factors.
先前的研究表明，可根据标准的半年期患者评估工具（PAI），为退伍军人事务部（VA）疗养院的长期居住者计算出反映褥疮发生、行为障碍和日常生活活动（ADL）恶化情况的临床指标。本研究旨在构建这些指标的全国性曲线，各疗养院未来可据此比较自身数值；并确定指标值与选定的疗养院特征之间的相关性。
根据1992年PAI数据，为69家VA疗养院中50名及以上长期居住（超过六个月）的居民计算了八项指标。这些指标包括：褥疮患病率；褥疮发病率；身体攻击性行为患病率；攻击性行为发病率；以及最初独立生活的居民在进食、行动、转移和如厕功能方面六个月丧失的频率。
八项指标中最有利四分位数与最不利四分位数之间存在两到六倍的差异。各机构之间在褥疮患病率与发病率、攻击性行为患病率与发病率以及最初独立生活的居民在四项ADL方面下降频率之间存在显著相关性。在具有以下特征的疗养院中，一项或多项指标显著更优：规模较小、居民周转率较低、患有非器质性精神病的居民比例较小以及短期居住与长期居住居民的比例较低、独立与依赖的长期居住居民比例较低。
这些数据提供了全国性标准，各VA疗养院可据此比较其从PAI得出的临床指标值。这些指标所衡量的结果似乎受到病例组合和环境因素的影响。
