학술논문
The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study).
Document Type
Article
Author
Hibbert, Peter D.; Molloy, Charlotte J.; Cameron, Ian D.; Gray, Leonard C.; Reed, Richard L.; Wiles, Louise K.; Westbrook, Johanna; Arnolda, Gaston; Bilton, Rebecca; Ash, Ruby; Georgiou, Andrew; Kitson, Alison; Hughes, Clifford F.; Gordon, Susan J.; Mitchell, Rebecca J.; Rapport, Frances; Estabrooks, Carole; Alexander, Gregory L.; Vincent, Charles; Edwards, Adrian
Source
Subject
*LONG-term health care
*MENTAL health services
*AUSTRALIANS
*OLDER people
*TERMINAL care
*NURSING home care
*
*
*
*
*
Language
ISSN
1741-7015
Abstract
Background: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. Methods: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. Results: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. Conclusions: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts. [ABSTRACT FROM AUTHOR]