Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data.
Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data.
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DOI：
10.1186/1756-0500-6-460
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发表时间：
2013-11-13
影响因子：
1.8
通讯作者：
Norton, Peter G
中科院分区：
文献类型：
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作者：
Estabrooks, Carole A;Knopp-Sihota, Jennifer A;Norton, Peter G
背景：近年来，提高养老院居民的护理质量引起了相当大的关注。因此，根据现有证据和专家共识，在居民评估工具-最低数据集2.0(RAI-MDS 2.0)中确定了质量指标(QI)，并将其确认为养老院护理质量的替代指标。我们试图确定对实践最敏感的QI；即那些被认为对临床实践最敏感的QI。方法：我们聘请了两名专家来审查35个有效QI的列表，并选择他们认为对实践最敏感的QI。然后，我们要求不同的执业医生、护士和政策制定者分组(1)对列表上的项目进行总体的“实践敏感性”排序，然后(2)确定QI对哪个领域最敏感(护理、医生护理或政策制定者)。结果：综合所有三组的结果，压疮被确定为最敏感的QI，其次是疼痛恶化、身体约束使用、使用未被诊断为精神病的抗精神病药物和留置导管。当按被调查者组分层时，尽管前五个QI保持不变，但13个QI的排名不同。结论：我们认为，除了确定一组减少的、可管理的QI用于定期报告外，我们认为关注这13个实践敏感型QI既能最大限度地改善居民的功能，又能减缓大多数居民经历的下降轨迹。
BACKGROUND: In recent years, improving the quality of care for nursing home residents has generated a considerable amount of attention. In response, quality indicators (QIs), based on available evidence and expert consensus, have been identified within the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0), and validated as proxy measures for quality of nursing home care. We sought to identify practice sensitive QIs; that is, those QIs believed to be the most sensitive to clinical practice.METHOD: We enlisted two experts to review a list of 35 validated QIs and to select those that they believed to be the most sensitive to practice. We then asked separate groups of practicing physicians, nurses, and policy makers to (1) rank the items on the list for overall "practice sensitivity" and then, (2) to identify the domain to which the QI was most sensitive (nursing care, physician care, or policy maker).RESULTS: After combining results of all three groups, pressure ulcers were identified as the most practice sensitive QI followed by worsening pain, physical restraint use, the use of antipsychotic medications without a diagnosis of psychosis, and indwelling catheters. When stratified by informant group, although the top five QIs stayed the same, the ranking of the 13 QIs differed by group.CONCLUSIONS: In addition to identifying a reduced and manageable set of QIs for regular reporting, we believe that focusing on these 13 practice sensitive QIs provides both the greatest potential for improving resident function and slowing the trajectory of decline that most residents experience.