背景:老年护理评估小组是澳大利亚老年护理系统的评估组成部分。他们的目的是进行基于需求的评估,以确定老年人的资格,以及获得英联邦资助的老年护理服务。从被评估人的角度来看,没有任何措施可以告诉我们老年护理评估服务是否具有高质量。澳大利亚的老年护理机构已经制定并引入了质量措施。然而,这些,没有考虑过生活在这种环境中的人的观点。还建议了家庭护理服务的质量措施。这项研究旨在通过要求老年护理评估服务的当前和未来服务用户对24个以人为本的质量指标(PC-QI)的重要性进行投票,来解决以人为本的质量指标方面的差距。这是在先前的研究中使用改进的Delphi方法方法开发的,该方法得到了消费者主导的咨询委员会的支持。
方法:这项混合方法研究使用RAND/UCLA适当性方法就最终的PC-QI集达成共识。布里斯班有25名居住在社区的老年人,澳大利亚,使用五点李克特量表对24个PC-QI的重要性进行了投票。在参与者投票之前,确定了消除PC-QI的共识声明。投票是与参与者面对面或通过电话单独进行的,在他们的家里。要捕获参与者提供的关于每个PC-QI的任何叙述,参与者投票会议被录音,随后被逐字转录。计算每个PC-QI参与者投票的定量数据,并通过中位数进行统计描述,四分位数间距,达成共识,百分位数,百分位排名,等级顺序,中位数和标准差。然后根据消除的共识声明对PC-QI进行评估,并根据对参与者的重要性进行排序。对来自音频转录的定性数据进行内容分析,以确定支持每个PC-QI的参与者投票的某些单词的存在。
结果:投票期间没有PC-QI被淘汰。参与者对每个PC-QI的重要性评分存在差异。最终质量域,各自的头衔,给出了质量指标描述符和支持定性数据。五个PC-QI的中位数为五个,没有低于4票的记录,四分位数间距为零,排名顺序得分为1,两个和四个,在可能的十个中,表明他们是最重要的参与者。
结论:参与者就24个基于证据的PC-QIs达成共识,这些PC-QIs代表了从当前和未来服务使用者的角度衡量老年护理评估服务质量的指标。
在澳大利亚,65岁或以上的人,原住民和托雷斯海峡岛民50岁或以上,可以申请获得澳大利亚政府资助的老年护理服务(澳大利亚政府,卫生和老年护理部门。2021-2022年《1997年老年护理法》运行报告,2022年)。政府资助的服务包括支持老年人在家生活,如果这个人不能住在家里,和短期康复(澳大利亚政府,卫生和老年护理部门。2021-2022年《1997年老年护理法》运行报告,2022年)。要访问这些服务,一个人需要填写申请表并接受老年人护理评估。另一个人可以帮助完成申请。老年护理评估的目的是评估个人的需求,以确定他们有资格获得哪些老年护理服务。从被评估人的角度来看,没有任何措施可以告诉我们老年护理评估服务是否具有高质量。在先前的研究中,在消费者咨询委员会的支持下,制定了24项质量指标(SmithS,TraversC,罗伯茨N,马丁·汗·M·健康预期,2024).这项研究询问了居住在布里斯班的25名老年人,24项措施的重要性,决定是否应该消除。人们被要求使用数字量表进行投票,其中排名第一的意思是“不重要”,五个意味着它“极其重要”。商定了一项协商一致声明,以决定是否取消一项措施。所有措施都被认为是重要的,没有取消任何措施。投票认为重要的质量措施包括接受知识渊博的医护人员的评估,他们以尊严和尊重的态度对待他们,采取以人为本的方法,建立了合作关系,并且沟通清楚。
BACKGROUND: Aged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person\'s eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended. This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous
study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board.
METHODS: This mixed methods
study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim. Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI.
RESULTS: No PC-QIs were eliminated during voting. Variation existed among participants\' ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants.
CONCLUSIONS: Participants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users.
In Australia, people 65 years or over, and Aboriginal and Torres Strait Islander Peoples 50 years or over, can apply to access aged care services funded by the Australian government (Australian Government, Department of Health and Aged Care. 2021-2022 Report on the Operation of the Aged Care Act 1997, 2022). Services the government funds include supporting older people to live at home, residential aged care if the person can’t live at home, and short-term rehabilitation (Australian Government, Department of Health and Aged Care. 2021-2022 Report on the Operation of the Aged Care Act 1997, 2022). To access these services, a person needs to fill out an application form and undergo an aged care assessment. Another person can help complete the application. The purpose of the aged care assessment is to assess the person’s needs to determine what aged care services they are eligible to access. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Twenty-four measures of quality were developed in a previous
study with support from a consumer Advisory Board (Smith S, Travers C, Roberts N, Martin‐Khan M. Health Expect, 2024). This
study asked 25 older people living in Brisbane, the importance of the 24 measures, to decide if any should be eliminated. People were asked to vote using a number scale where number one meant it ‘wasn’t important’, and five meant it was ‘extremely important.’ A consensus statement was agreed to decide if a measure would be eliminated. All measures were voted as being important with no measure eliminated. Quality Measures voted as being important included receiving assessments from knowledgeable health care staff, who treated them with dignity and respect, adopted a person-centred approach, established a collaborative relationship, and communicated clearly.