Quality Indicators of Primary Care Provider Engagement in Nursing Home Care
Quality Indicators of Primary Care Provider Engagement in Nursing Home Care
复制标题
DOI：
10.1016/j.jamda.2018.08.001
复制
发表时间：
2018-10-01
影响因子：
7.6
通讯作者：
Katz, Paul R.
中科院分区：
文献类型：
--
作者：
Mays, Allison Moser;Saliba, Debra;Katz, Paul R.
这里描述的倡议旨在确定质量指标（QIs）密切相关的国际实践中的初级保健提供者（PCP）在急性和长期护理，以证明医疗提供者在疗养院（NH）的附加值。一个由7名成员组成的国际团队确定了现有的QI并使其适应医疗提供者的AMDA能力。QI来源包括ACOVE 3质量指标（2007年），NH质量指标（2004年），NH住宅护理质量指标（2002年）和AGS明智选择（2014年）。我们招募了一个技术专家小组（TEP），由来自美国、加拿大和欧盟的11名专家组成，他们因其在急性期后和长期护理方面的知识和领导能力而被选中。TEP采用兰德公司改进的德尔菲法，提供会前评分，亲自讨论项目以澄清问题，并在讨论后对项目进行重新评分。当小组成员将特定QI的1个以上选项评定为有效和可行时，选择最严格的选项以纳入最终候选QI组。小组成员对最初的103个项目的有效性和实施的可行性进行了保密评级。在会议期间，小组成员增加了18个质量指标，并修改了18个。在会后分析中，我们排除了7个被评为无效的QI和9个被评为有效和可行的更严格的QI。这导致最终一组97个被评定为有效和可行的质量指标，8个被评定为有效但不可行。这套针对NH PCP的QIs确定了提供者参与通过老年综合征专业知识增加价值的做法，采用循证实践，倡导居民，提供以人为本的护理，促进提前护理计划，并有效沟通以协调护理。接下来的步骤包括试点测试和评估遵守QIs，PCP人员配备模式和更好的结果之间的关联。爱思唯尔公司出版代表AMDA -急性后和长期护理医学协会。
The initiative described here aims to identify quality indicators (QIs) germane to the international practice of primary care providers (PCP) in post-acute and long-term care in order to demonstrate the added value of medical providers in nursing homes (NHs). A 7-member international team identified and adapted existing QIs to the AMDA competencies for medical providers. QI sources included the ACOVE 3 Quality Indicators (2007), NH Quality Indicators (2004), NH Residential Care Quality Indicators (2002), and AGS Choosing Wisely (2014). We recruited a technical expert panel (TEP) consisting of 11 panelists from the US, Canada, and the European Union, selected for their knowledge and leadership in post-acute and long-term care. The TEP, using a RAND Modified Delphi approach, provided pre-meeting ratings, discussed items in-person for clarification, and re-rated items following discussion. When panelists rated more than 1 option for a particular QI as valid and feasible, the most stringent option was selected for inclusion in the final candidate set of QIs. Panelists confidentially rated an initial 103 items on validity and feasibility of implementation. During the meeting, panelists added 18 QIs and modified 18. In post-meeting analysis, we eliminated 7 QIs rated not valid and 9 QIs for which a more stringent QI was rated valid and feasible. This resulted in a final set of 97 QIs rated valid and feasible and 8 rated valid but not feasible. This set of QIs for PCPs in the NH identified practices in which provider engagement adds value through expertise in geriatric syndromes, employing evidence-based practice, advocating for residents, delivering person-centered care, facilitating advance care planning, and communicating effectively to coordinate care. Next steps include pilot testing and evaluating the association between adherence to QIs, PCP staffing models, and better outcomes. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.