Construction And Preliminary Application Of Quality Evaluation Index System Of Fall Prevention For Elderly Inpatients From Multi-Disciplinary Perspectives

Objective1.To construct quality evaluation index system of fall prevention in elderly inpatients from multi-disciplinary perspectives based on the "structures-processes-results" model,providing theoretical reference for standardized management of fall prevention.2.To verify effectiveness and feasibility of the quality evaluation index system of preventing falls in elderly inpatients through preliminary application in clinic.Methods1.Review the relevant literatures on the prevention and management of falls in the elderly,summarize the evidences for the prevention falls in the elderly at home and abroad,and extract the high-risk factors affecting the fall of the elderly and relevant preventive measures.Semi-structured interviews were conducted with 26 relevant personnel to obtain the key indicators of fall prevention in elderly hospitalized patients,and the quality evaluation index system of fall prevention in elderly inpatients from multi-disciplinary perspectives was initially formed.2.Through Delphi method,40 experts who met the standards were selected for two rounds of expert consultation,and the quality evaluation index system was modified according to expert suggestions.The weight of the index was assigned by analytic hierarchy process,and the consistency of the weight of the index was tested.3.Through field investigation,three process indicators(accurate and timely assessment timing of fall prevention in multi-disciplinary team,correct use of fall risk assessment tools in multi-disciplinary team,accurate assessment of fall risk level)and one outcome indicator(compliance rate of fall prevention measures implemented by multi-disciplinary team members)were preliminarily applied in clinic to verify their effectiveness.Results1.A total of 9 articles meeting the inclusion and exclusion criteria were finally included by searching Chinese and English databases.After literature quality evaluation and evidence summary,33 best evidences were finally summarized,including 6 aspects of fall risk factor assessment,fall risk assessment,fall risk screening,fall intervention,fall follow-up and team building.Semi-structured interviews were conducted with a total of 26 respondents and 2 themes were summarized.Integrating the results of literature review and qualitative research,combined with the actual clinical needs,the quality evaluation index system of fall prevention in elderly inpatients from the multidisciplinary perspective was initially formed,including 14 second-level indicators and 38 third-level indicators.2.A total of 40 experts were invited for two rounds of expert letter consultation.The recovery rates of the two rounds of questionnaire were 97.56% and 100%,the authority coefficients of the two rounds of expert opinions were 0.80 and 0.92 respectively,and the coordination coefficients of the two rounds of expert opinions were both 0.04.The mean value of the importance assignment of the first-level indicators was 4.85～4.93 in the first round of expert consultation,the coefficient of variation was 0.05～0.08,and the full mark rate was 85.40%～92.70%.The mean importance assignment of the second-level indicators was 4.71～4.95,the coefficient of variation was 0.05～0.15,and the full score rate was 75.60%～95.10%.The mean importance assignment of the three-level indicators was 4.68～4.95,the coefficient of variation was 0.05～0.18,and the full score rate was 78.00%～95.10%.The mean value of the importance assignment of the first-level indicators was 4.98 in the second round of expert consultation,the coefficient of variation was 0.03,and the full mark rate was 97.50%.The mean importance assignment of the second-level indicators was 4.83～5.00,the coefficient of variation was 0.00～0.08,and the full score rate was 82.50%～100.00%.The mean importance assignment of the three-level indicators was 4.78～4.98,the coefficient of variation was 0.03～0.12,and the full score rate was 82.50%～97.50%.The index evaluation system was revised and improved after two rounds of expert consultation,and finally the evaluation index system for the quality of fall prevention in elderly inpatients was formed with 3 first-level indicators,15 second-level indicators and 39 third-level indicators from the multidisciplinary perspective.The consistency test of the index system at all levels showed that the CR value of random consistency test was0.000～0.046 for each layer.All of them were less than 0.1.3.The 27 items of 4 indicators were checked for 3 months,and a total of 6152 people were checked.Within 3 months after the implementation of the examination,the longitudinal comparison of the examination data of each index had varying degrees of fluctuation.When the indicators were compared horizontally,the compliance rate of accurate assessment and implementation of fall prevention timing in multidisciplinary team was low,which needs to be further improved.Conclusion1.We constructed a quality evaluation index system of preventing falls in elderly inpatients from multi-disciplinary perspectives based on "structures-processes-results" model in this study.The practical and sensitive quality evaluation indicators were constructed through quantitative and qualitative research methods,which had high scientific significance and could provide a quality evaluation tool for the management of fall prevention in elderly inpatients.2.Through preliminary application,the quality evaluation index system of fall prevention in elderly hospitalized patients from multi-disciplinary perspectives has good clinical applicability,and can provide practical references for clinical medical personnel to improve the quality of fall prevention management.