北京市失能老人上门医疗服务评估指标体系的构建

Establishing an evaluation system for the disabled elderly in home health care services in Beijing

目的为促进北京市社区卫生服务机构为失能老人提供有效的上门医疗服务,构建了北京市失能老人上门医疗服务评估指标体系。方法基于对前期查阅的政策文件、文献和成熟的评估工具的研究,初步拟定了评估指标条目池,并设计了专家咨询表。在全国范围内选择在上门医疗服务或老年综合评估领域富有经验的综合医院老年科医生、社区全科医生及社区护士共15名专家,在2019年1—5月通过邮件向专家下发专家咨询表,进行两轮德尔菲法专家咨询,并统计专家的个人信息以及专家权威程度相关指标,建立失能老人上门医疗服务评估指标体系。结果两轮咨询下发的专家咨询表均全部回收且全部有效,专家积极系数均为100.0%,15名咨询专家权威程度在0.700~0.942,平均为0.847,达到了可接受的标准。第一轮专家咨询的指标重要性、可行性专家协调系数分别为0.172和0.207(均P<0.001),第二轮分别为0.301和0.314(均P<0.001),专家意见趋于一致,咨询结果可靠。最终构建的失能老人上门医疗服务评估指标体系包括了服务安全、身体一般状况、认知与精神状态、躯体功能、日常生活能力和环境与资源共6项一级指标和28项二级指标。结论咨询专家具有很高的积极性,且专家的权威程度较高。两轮咨询后专家对各一、二级指标的评价意见趋于一致,有足够的协调性,本研究构建的失能老人上门医疗服务评估指标体系结果可信。

Objective To establish the evaluation system of home health care services for the disabled elderly for promoting the community health service institutions in Beijing to provide home health care services for the disabled elderly.Methods Based on the research of the policy documents,documents and mature evaluation tools,the paper preliminarily draws up the item pool of evaluation indexes and designs the expert consultation table.A total of 15 experts,including geriatricians,general practitioners and community nurses,who were experienced in home health care services or comprehensive elderly assessment in nationwide were invited to participate two rounds of Delphi consultation to determine the evaluation system from January to May 2019.Results The expert consultation forms were all recalled and valid.The active coefficient of experts of Delphi consultation in two rounds were 100.0%,and the degree of specialist authority was between 0.700 and 0.942,with an average of 0.847,reaching the acceptable standard.The coefficient of concordance of importance and feasibility were 0.172 and 0.207 respectively(all P<0.001)in the first round of consultation,and the second round were 0.301 and 0.314 respectively(all P<0.001).The expert opinions tended to be consistent and the consultation results were reliable.The final evaluation system included 6 first-class indexes and 28 second-class indexes,including service safety,general physical condition,cognitive and mental state,physical function,ability of daily living and environment and resources.Conclusion The experts have great initiative and authority on research subjects.After two rounds of consultation,the experts`opinion tend to be consistent and have enough coordination.The evaluation system of home health care service for the disabled elderly in this study is credible.