Caring for patients with dementia: How good is the quality of care? results from three health systems
Caring for patients with dementia: How good is the quality of care? results from three health systems
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DOI：
10.1111/j.1532-5415.2007.01249.x
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发表时间：
2007-08-01
影响因子：
6.3
通讯作者：
Vickrey, Barbara G.
中科院分区：
文献类型：
--
作者：
Chodosh, Joshua;Mittman, Brian S.;Vickrey, Barbara G.
目的：描述一个美国大都市地区的痴呆症护理质量，并调查质量变化与患者、护理人员和卫生系统特征之间的关联。设计：观察性、横断面。设置和参与者：来自三个医疗保健组织的387对患者-护理人员测量：使用照顾者调查和病历摘要来评估从现有指南中提取的18个痴呆症护理过程，计算每个护理过程的依从比例，以及在四个护理维度内汇总的平均坚持百分比：评估（6个过程）、治疗（6个过程）、教育和支持（3个过程）和安全（3个过程）。对于每个维度，依从性和患者，护理人员，和卫生系统的特性之间的关联进行了调查，使用多变量models.Results：依从性范围从9%到79%的18个单独的护理过程，11个过程有不到40%的坚持。四个护理维度的平均依从性百分比为：评估为37%，治疗为33%，教育和支持为52%，安全性为21%。更高的合并症与所有四个维度的更高依从性相关，而更高的护理知识（特别是一个项目）与四个护理维度中的三个护理质量相关。对于选定的尺寸，更大的坚持也与更大的痴呆症的严重程度和更多的老年病或神经科visits.Conclusion：在一般情况下，痴呆症的护理质量有相当大的改进空间。虽然更大的合并症和痴呆的严重程度与更好的质量，照顾者的知识是最一致的照顾者的特点与更好的遵守。这些发现为针对低质量提供了机会，并提出了潜在的重点干预措施。
Objectives: To describe the quality of dementia care within one U.S. metropolitan area and to investigate associations between variations in quality and patient, caregiver, and health system characteristics.Design: Observational, cross-sectional.Setting and Participants: Three hundred eighty-seven patient-caregiver pairs from three healthcare organizationsMeasurements: Using caregiver surveys and medical record abstraction to assess 18 dementia care processes drawn from existing guidelines, the proportion adherent to each care process was calculated, as well as mean percentages of adherence aggregated within four care dimensions: assessment (6 processes), treatment (6 processes), education and support (3 processes), and safety (3 processes). For each dimension, associations between adherence and patient, caregiver, and health system characteristics were investigated using multivariable models.Results: Adherence ranged from 9% to 79% for the 18 individual care processes; 11 processes had less than 40% adherence. Mean percentage adherence across the four care dimensions was 37% for assessment, 33% for treatment, 52% for education and support, and 21% for safety. Higher comorbidity was associated with greater adherence across all four dimensions, whereas greater caregiver knowledge (in particular, one item) was associated with higher care quality in three of four care dimensions. For selected dimensions, greater adherence was also associated with greater dementia severity and with more geriatrics or neurologist visits.Conclusion: In general, dementia care quality has considerable room for improvement. Although greater comorbidity and dementia severity were associated with better quality, caregiver knowledge was the most consistent caregiver characteristic associated with better adherence. These findings offer opportunities for targeting low quality and suggest potential focused interventions.