Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program
Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program
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DOI：
10.1111/jgs.14251
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发表时间：
2016-08-01
影响因子：
6.3
通讯作者：
Reuben, David B.
中科院分区：
文献类型：
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作者：
Jennings, Lee A.;Tan, Zaldy;Reuben, David B.
多项研究表明，初级保健中的痴呆症护理质量很差，医生遵守痴呆症质量指标 (QI) 的比例为 18% 至 42%。为此，加州大学洛杉矶分校 (UCLA) 卫生系统创建了加州大学洛杉矶分校阿尔茨海默氏症和痴呆症护理 (ADC) 计划，这是一项质量改进计划，该计划采用共同管理模式，由执业护士痴呆症护理经理 (DCM) 与初级保健医生和社区组织合作，提供全面的痴呆症护理。目的是使用弱势老年人护理评估 (ACOVE-3) 和绩效改进医师联盟 QI 来衡量执业护士 DCM 提供的痴呆症护理质量。参与者包括 797 名患有痴呆症的社区居民，他们在 2 年的时间内接受了 UCLA ADC 项目的治疗。加州大学洛杉矶分校是一个城市学术医疗中心，主要提供按服务付费报销。测量了 17 种痴呆症 QI 所接受的推荐护理的百分比。主要结果是 UCLA ADC 队列的总体护理质量，计算方法为收到的推荐护理流程总数除以合格质量指标总数。次要结局包括痴呆症护理三个领域的总体护理质量：评估和筛查（7 个 QI）、治疗（6 个 QI）和咨询（4 个 QI）。 QI 是从初始评估之日起 3 个月内的 DCM 注释中提取的。个人有资格参加 9,895 项 QI，其中 92% 通过。 DCM 的总体通过率相似（90-96%）。所有咨询和评估质量的通过率均超过80%，大多数超过90%。在针对痴呆症治疗的 QI 中发现了更大的依从性，这是由患者特定标准触发的，从 27% 的因精神状态变化而停药到 86% 的讨论乙酰胆碱酯酶抑制剂。与执业护士共同管理全面的痴呆症护理可以为痴呆症提供高质量的护理，特别是评估、筛查和咨询。对治疗质量的影响变化更大，但高于之前医生提供的痴呆症护理的报告。
Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive dementia care comanagement with a nurse practitioner can result in high quality of care for dementia, especially for assessment, screening, and counseling. The effect on treatment QIs is more variable but higher than previous reports of physician-provided dementia care.