Construction Of Care Complixety Evaluation Index System For ICU Patients

Objective(1)The care complexity evaluation index system for ICU patients was constructed by literature review,group discussion,expert consultation,analytic hierarchy process,and project analysis.(2)121 patients from a tertiary hospital in Lanzhou were selected by convenience sampling,and relevant information was collected to conduct preliminary validation of the ICU patient care complexity evaluation index system.Methods(1)Literature review and Group discussionSearch Pub Med,Embase,Cochrane Library,Web of science,CNKI,Wanfang,Sino Med,VIP,and the search time was until October,2021.The relevant information was extracted by Excel 2019.The evaluation index pool for ICU patient care complexity was proposed after a group discussion.(2)Delphi Method and Project analysisWe used Excel 2019 and SPSS 25.0 to analyze the data,and based on expert inquiry results,the preliminary evaluation index for ICU patient care complexity was determined.86 patients admitted to ICU of a Grade-A hospital in Lanzhou from February to March 2022 were selected to collect relevant information for project analysis.(3)Analytical hierarchy processThe data were analyzed using YAAHP to determine the importance of the evaluation indicators,and generate the ICU patient care complexity evaluation form.(4)Reliability and validity verification121 patients admitted to ICU of a Grade-A hospital in Lanzhou City from May to July 2022 were selected by convenience sampling and their relevant information will be collected for analysis.Results(1)Literature review and Group discussionLiterature review and group discussion: In this study,a total of 1710 articles were retrieved.After removing duplicate articles and screening according to the eligibility and non-eligibility criteria,32 studies were finally included.According to the results of literature review and combined with clinical practice,we modified 6secondary indexes and preliminarily developed an evaluation index system for ICU patient care complexity difficulty.(2)Delphi Method and Project analysis19 experts from 14 different provinces in the areas of critical medicine,critical care,and nursing management were consulted via questionnaires.The effective response rates for the two rounds of questionnaires were 95% and 100%,respectively.The average authority coefficient of the experts was 0.8553,and the coordination coefficients for the for the first,second,and third indicators ranging from 0.45 to 0.67,and gradually increased.Out-hospital transfer,blood glucose management,pain management,anesthesia resuscitation and traditional Chinese medicine treatment did not meet the inclusion criteria of the indicators in project analysis stage,so the 5indicators were deleted.(3)Analytical hierarchy processThe average priority of the main indicators ranged from 0.0719 to 0.5884,with the treatment category receiving the most weight and the general condition receiving the least.The average weights of the secondary indicators were between 0.0685 and0.6820,and the average weights of the tertiary indicators were between 0.1070 and0.6573.(4)Reliability and validity verificationReliability and validity analysis revealed a standardized Cronbach’s α of 0.7458,indicating high reliability and good internal consistency.Content validity was good,with I-CVI values ranging from 0.875 to 1,exceeding 0.78,and an S-CVI value of0.99,exceeding 0.9.Moreover,the KMO value was 0.6014,greater than 0.6,and the Bartlett sphericity test was statistically significant(χ 2=811.5228,P<0.001).By employing principal component analysis to extract common factors and applying maximum variance orthogonal rotation,it was discovered that 8 factors possessed eigenvalues that were greater than 1,contributing to a cumulative variance of 67.22%.ConclusionThis study developed an indicator system for evaluating the difficulty of nursing ICU patients,which includes 3 primary indicators,10 secondary indicators,and 23 tertiary indicators,covering general condition,disease assessment,and treatment project.The content is comprehensive,hierarchical,and the weight setting is reasonable.It can objectively evaluate the difficulty of nursing ICU patients with satisfactory reliability and validity.