| Objective Our study attempted to analyze the service status of the geriatric care facilities in Shanghai based on the theory of nursing quality management and control. On this basis, a scientific and practical set of quality indicators of elderly care was established,so as a comprehensive evaluation model to evaluate and monitor the quality of elder care.Methods The research status and development trend of nursing quality evaluation of the elderly medical services at home and abroad were systematically reviewed through literature research,and a questionnaire on the service status of the geriatric care facilities in Shanghai was designed. From May 15th to July 15th in 2014,270 geriatric care facilities were investigated. Based on the results of literature research and survey data, the "structure-process - outcome" evaluation model combined with semi-structured interview and Delphi method were used to construct the quality indicators of elderly care and determine the weight of each indicator. Based on synthetical scored method, a comprehensive evaluation model was developed and tested in 10 elderly care institutions to verify its effect.Results1. Survey on the service status of the geriatric care facilities in Shanghai Service status of 25 independent elderly care institutions Overall size: 15 private institutions, 10 public institutions, a total of 5151 approved beds, a total of 6307 actual open beds, 4981 approved elderly beds, 6140 actual open beds for the elderly, and the average length of hospital stay was 140 days.Characteristics of admitted elder patients: the majority of elderly patients was aged 75 to 89, accounting for 67%, followed by 90, accounting for 17%, 60 to 74 years old accounted for 16%. In these elderly patients, female accounted for 52.69%, and male accounted for 47.31%. The top five diseases that these hospitalized elderly patients suffered from were nervous system diseases, circulatory diseases, respiratory diseases,genitourinary system diseases and digestive diseases. 65% patients could not perform self care, 26% patients performed part self care, and only 9% petients could conduct complete seflf care.Facilities: 25 institutions were equipped with bath, pharmacy and health care office.92% to 80% of the institutions were equipped with ECG room, physical treatment room,treatment room, laboratory, B ultrasound room and operation treatment room; 76% to 60%of the institutions were equipped with catering rooms, exercise rooms, X-ray rooms,emergency rooms and disinfection rooms; however, only 48% of institutions had hospice care rooms. All institutions were equipped with ECG machine, oxygen cylinder suction device, UV, monitoring equipment, computer and network equipment. 96% to 84% of the institutions were equipped with air-cushion beds, physical therapy equipment, B ultrasound machine, sterile cabinets, exercise therapy equipment and operation therapy equipment;76% to 60% of the institutions were equipped with Bath special chair bench, X-ray machine and rescue bed.56% were equipped with wireless call equipment and video recorders, 36% with positioning equipment, and 32% with a bath bed.Human resources allocation: Human resources in the elderly medical institutions were divided into four types, including medical personnel, medical technician, nurses and nursing assistants. The nursing assitant was the majority, accounting for 37.91%, followed by nurses (29.11%), medical staff (19.62%) and medical technician (13.35%). The doctors/ nurses ratio was 1: 1.48, bed / nursing staff ratio was 1: 0.41 (including registered nurses and nursing assistants),and nurses / nursing assistants ratio was 1: 1.30.Distribution of medical and nursing adverse events: From 2011 to 2013, a total of 567 adverse events occurred, and the top five adverse events were falls / fall bed events,drug events, catheters events, dietary events and infusion events.Construction of management system: The institutional system was basically complete, but for transfer system, the adverse events handling and registration system,training, evaluation, reward and punishment system, quality management system and technical file management system, each system remained unfouned in two institutions.Three institutions did not have post management system, or hospital infection control system, or medical care technical procedures. There were four institutions without equipment operating procedures.(2) Service status of 245 independent elderly care institutionsOverall size: In those 245 institutions, 30 had no approved bed set, 44 had no actual bed set, and the number of approved and actual elderly care beds of 107 institutions was 0.The total number of beds approved in the city's community health service center was 15443, the otal number of actual opening was 16875, the number of elderly beds approved was 6800, the number of elderly beds actual opening was 10265, and the average length of hospital stay was 119 days.Characteristics of admitted elder patients: the majority of elderly patients was aged 75 to 89, accounting for 68%, followed by 90, accounting for 16%, 60 to 74 years old accounted for 16%. In these elderly patients, female accounted for 53.45%, and male accounted for 46.55%. The top five diseases that these hospitalized elderly patients suffered from were circulatory system diseases, nervous system diseases, respiratory diseases, digestive diseases and tumors. 49% patients could not perform self care, 32%patients performed part self care, and only 19% petients could conduct complete seflf care.Facilities: 89.47% ?80.53% of the community health service centers were equipped with health care office, pharmacy, electrocardiogram room, B ultrasound room,laboratory,X-ray room,bath room and treatment room.77.37% ?61.58% of the 245 institutions had rescue room, disinfection room, meal room, physical treatment room and exercise room. 45.79% were equipped with operating treatment room, 27.89% with hospice care room. 97.37% ?80.53% of the units were equipped with ECG machine,oxygen cylinder, UV lamp, suction device, B ultrasound machine, X-ray machine,computer and network equipment, monitoring equipment, rescue bed, sterile cabinet and physical therapy equipment.74.74% ? 50% were equipped with air-cushion bed, exercise therapy equipment,operation therapy equipment and wireless call equipment.48.42% were equipped with video recorders, 34.21% with bath stool,16.84% with bath bed and 13.68%with positioning equipment.Human resources allocation: Human resources in the community health service centers were divided into four types, including medical personnel, medical technician,nurses and nursing assistants .The medical personnel was the majority, accounting for 36.47%, followed by nurses (34.59%), medical technician (14.80%) and nursing assistants(14.14%).The doctors / nurses ratio was 1 : 0.95, bed / nursing staff ratio was 1: 0.31 , and nurses / nursing assistants ratio was 1: 0.41.Distribution of medical and nursing adverse events: From 2011 to 2013, a total of 3487 adverse events occurred, and the top five adverse events were drug events, falls / fall bed events, catheters events, infusion events and traumatic events.Construction of management system: More than 80% of the centers have established transfer procedures, adverse event handling and registration reporting systems, training,evaluation and rewards and penalties, quality management systems, hospital infection control systems and medical care technical procedures, but 25% to 28% units had no personnel positions management, technical file management or equipment management system.2?Through the semi-structured interview and Delphi method, quality evaluation indicator system of elderly care including 3 primary indicators (i.e., structure, process and result), 9 secondary indicators (e.g., personnel, materials and environment), and 32 tertiary indicators (e.g., nurse - patient ratio, average daily nursing time of hospitalized patients,and the rate of restraints use) was constructed. The positive coefficients of the two rounds of expert consultation were 100% (> 60%), the authority of the experts were 0.876 and 0.861 (? 0.7), the coefficients of variation among each indicator were 0-0.14.3 ? After weighting each quality indicator of elder care and applying synthetical scored method, a comprehensive evaluation model for elder care was developed. Totally 20 geriatric care facilities were randomly seleted to test the feasibility of the evalutation model. Then, we applied three quality evaluation methods to verify the results and they show positive correlation with each other (P<0.01).Conclusion1 ? This study analyzed the service status of the geriatric care facilities in Shanghai,showing that the elderly health care institutions were lack of elderly care management standards and norms, the key links of quality control of elderly care management was weak, the contradictions during team-building of elderly care service were obvious, and the level of elderly medical care service was low.2?A set of quality evaluation indicator system of elderly care including 32 indicators was constructed. Furthermore, the weight and calculation formula of each indicator were determined.3?A comprehensive evaluation model of elder care was developed based on synthetical scored method, and its feasibility and scientificity were verified after comparing with weight rank-sun ratio method and expert evaluation. The results showed this evaluaiton model could play a good role in clinical guidance. |
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