老年长期照护分级评估人员及流程的定性研究

Preliminary establishment of personnel qualifications for elderly care level rating and rating process of long term care for the elderly

目的探讨老年长期照护分级评估人员组成及评估流程。方法在文献研究、理论析取及质性访谈基础上初步确立分级评估人员组成及评估流程草图,运用Delphi法对25名专家进行2轮函询。结果质性访谈提取老年长期照护分级评估人员组成、建立老年长期照护分级评估流程2个主题。专家权威系数第1轮0.948、第2轮0.951;Kendall′s W系数第1轮0.100(P>0.05)、第2轮0.246(P<0.01)。7个评估流程各环节重要性得分(4.24±0.66)～(4.92±0.28);评估人员组成、培训重要性得分均为4.92±0.28。最终形成提出申请—初评—评估—确定分级—复评的评估流程。结论老年长期照护分级评估人员应由具有5年以上工作经验的医生、护士等医学工作者组成的专业团队构成,条件允许情况下优先考虑由护士主导评估团队的整体运行;团队内所有评估人员均必须经过专业培训,经考核合格后才能担任评估职能。分级评估流程的制定应基于我国基本国情,以社区和养老机构为初评立脚点,应根据受照护老年人具体情况实行弹性评估。

Objective To discuss the personnel qualifications for elderly care level rating and rating process of long term care for the elderly.Methods The personnel qualifications for elderly care level rating and rating process flow chart of long term care for the elderly were drafted based on literature reviews,theory analysis,and qualitative interviews,and then subjected to 2 rounds of expert consultation which involved 25 experts through the Delphi method.Results Qualitative interviews yielded two themes:one involving the personnel qualifications for elderly care level rating,and the other confirming the necessity of building a rating process of long term care for the elderly.The expert authority coefficient was 0.948 for the first,and 0.951 for the second round;Kendall′s conformance coefficient was 0.100(P>0.05)for the first,0.246(P<0.05)for the second round.The importance scores of each part of the 7-part rating processes averaged between(4.24±0.66)and(4.92±0.28);the importance scores of personnel qualifications for elderly care level rating and training necessity reached 4.92±0.28.Finally,a rating process of filing application-initial rating-preliminary assessment-confirming rating-second assessment was finalized.Conclusion The personnel responsible for elderly care level rating should be a member of the medical team,eg,a doctor or a nurse with more than 5 years of working experience.If conditions permit,a nurse as a rater is preferred.All members of the medical team should be subjected to professional trainings to possess qualifications before shouldering on rating task.The formulation of the rating process should be based on domestic conditions.Community health service centers and elder care institutions should assume the task of initial rating,and flexible assessment should be carried out on the basis of specific circumstances of the elderly.