The uniform postacute assessment tool: Systematically evaluating the quality of measurement evidence
The uniform postacute assessment tool: Systematically evaluating the quality of measurement evidence
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DOI：
10.1016/j.apmr.2007.08.117
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发表时间：
2007-11-01
影响因子：
4.3
通讯作者：
Greene, Maureen
中科院分区：
文献类型：
--
作者：
Johnston, Mark V.;Graves, Daniel;Greene, Maureen
Johnston MV、Graves D、Greene M。统一的急性后评估工具：系统评估测量证据的质量。 Arch Phys Med Rehabil 2007;88:1505-12。美国国会要求医疗保险和医疗补助服务中心开发一种统一的评估工具，以描述患者对急性期后服务的需求。应该使用什么科学标准来评估这种工具的证据？只有明确定义测量的结构及其应用，才能准确地对测量的有效性进行评级。我们认为，改善急性期后安置是统一急性期评估（最近更名为连续性评估记录和评估）的主要目的。我们认为，需要根据治疗和护理水平和类型的转变来更好地定义和衡量安置本身。为提供适当的康复安置建议而应衡量的领域包括熟练的医疗和护理水平、治疗、日常生活支持、家庭支持、参与自我护理的能力以及患者的偏好。几乎没有进行任何研究来量化和预测所需的康复治疗强度，这是证据上的一个主要缺陷。为研究提供了标准和示例，这些研究将为建议护理过渡的系统的有效性提供最少的、可能充分的或强有力的证据。需要一个长期的研究计划和系统的证据综合来支持改善急性期后安置的指南。
Johnston MV, Graves D, Greene M. The uniform postacute assessment tool: systematically evaluating the quality of measurement evidence. Arch Phys Med Rehabil 2007;88:1505-12.The U.S. Congress has mandated that the Centers for Medicare & Medicaid Services develop a uniform assessment instrument that characterizes patients' needs for postacute services. What scientific criteria should be used to evaluate the evidence for such a tool? The validity of a measure can be accurately graded only if the constructs measured and their applications are clearly defined. We argue that improving postacute placement is the main purpose of the uniform postacute assessment (recently renamed the Continuity Assessment Record and Evaluation). We argue that placement itself needs to be better defined and measured in terms of transitions in the level and type of treatment and care. Domains that should be measured to provide appropriate rehabilitative placement recommendations include level of skilled medical and nursing care, therapies, routine living support, family support, ability to participate in self-care, and patient preference. Almost no research has been performed to quantify and predict the needed intensity of rehabilitative therapy, a major lacuna in evidence. Criteria and examples are provided for research that will provide minimal, probably adequate, or strong evidence for the validity of systems that recommend care transitions. A longterm program of research and systematic evidence synthesis is needed to support guidelines that improve postacute placement.