Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment
Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment
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DOI：
10.1111/j.1553-2712.2011.01092.x
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发表时间：
2011-06-01
影响因子：
4.4
通讯作者：
Miller, Douglas K.
中科院分区：
文献类型：
--
作者：
Carpenter, Christopher R.;Heard, Kennon;Miller, Douglas K.
背景资料：老年人在急诊科（艾德）使用者中所占的比例越来越大，特别容易患急性疾病。卫生保健提供者最近开始注重制定质量指标（QIs），以确定最低护理标准。目标：该项目的最初目标是在药物管理、筛查和预防以及功能评估领域内为老年患者开发额外的ED特定QIs，但证据的数量和质量都不足以证明这三个领域的明确最低护理标准是合理的。因此，作者修改了项目的目标，以确定关键的研究机会，在这三个领域，可用于开发QIs在future.Methods：每个域被分配一个或两个内容的专家谁创造了潜在的QIs的基础上，系统的文献综述，专家意见的补充。然后由四个小组对候选QIs进行审查：学术急救医学学会（SAEM）老年工作组，SAEM老年兴趣小组，以及2008年SAEM年会和2009年美国老年学会年会的观众，使用匿名观众响应系统技术以及口头和书面反馈。结果：基于以患者为导向的结果的高质量证据在所有三个领域都是不足或不存在的。与会者没有就任何拟议的质量指标达成共识。药物管理（三），筛查和预防（二），和功能评估（三）的关键研究问题提出了建议的QIs，大多数参与者accepted.Conclusions的基础上：在评估的最低标准的护理，系统地获得老年QIs的药物管理，筛查和预防，功能评估，令人信服的临床研究证据是缺乏的。以病人为导向的研究问题，是必不可少的，以证明和表征未来的QIs在这些领域进行了描述。学术急诊医学2011; 18：644-654（C）2011由学术急诊医学学会
Background: Geriatric adults represent an increasing proportion of emergency department (ED) users and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus on the development of quality indicators (QIs) to define a minimal standard of care.Objectives: The original objective of this project was to develop additional ED-specific QIs for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence were insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop QIs in the future.Methods: Each domain was assigned one or two content experts who created potential QIs based on a systematic review of the literature, supplemented by expert opinion. Candidate QIs were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback.Results: High-quality evidence based on patient-oriented outcomes was insufficient or nonexistent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (three), screening and prevention (two), and functional assessment (three) are presented based on proposed QIs that the majority of participants accepted.Conclusions: In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future QIs within these domains are described. ACADEMIC EMERGENCY MEDICINE 2011; 18:644-654 (C) 2011 by the Society for Academic Emergency Medicine