上海市老年医疗护理机构脑卒中护理质量评价指标体系构建

发布时间：2018-01-04 20:41

本文关键词：上海市老年医疗护理机构脑卒中护理质量评价指标体系构建　出处：《第二军医大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:针对上海市老年医疗护理机构脑卒中患者护理现况,构建《上海市老年医疗护理机构脑卒中护理质量评价指标体系》,并对该质量评价指标体系进行临床验证研究,以期为提高上海市老年医疗护理机构脑卒中护理质量,改善卒中患者结局,实现医疗护理资源的高效利用提供依据。研究方法:在对上海市现有老年护理(医)院、社区卫生服务中心以及设置老年医疗护理床位的综合医院三类老年医疗护理机构的脑卒中护理现况调研的基础上,以单病种临床护理路径为指导,通过循证护理研究,初步构建上海市老年医疗护理机构脑卒中护理质量评价指标体系;再通过两轮德尔菲专家咨询法,确立上海市老年医疗护理机构脑卒中护理质量评价指标体系。以上海市老年护理管理质量控制中心督查范畴内的某老年护理院为试点,对该质量评价指标体系进行实证研究,以验证其临床有效性和可行性。研究结果:1、现况调研表明:目前,在上海市老年医疗护理机构中,老年脑卒中患者呈现高龄化趋势,80岁以上患者占2015年老年医疗护理机构收治脑卒中患者总数的55.39%;其中女性患者超过男性,占55.40%;脑卒中患者住院天数在10~637天之间;各机构对脑卒中患者日常生活活动能力评估、神经系统功能评估等护理评估的执行情况差异较大。2、根据循证方法,通过系统检索以及指南质量评价,最终纳入20篇文献,包括10篇系统评价、6篇证据汇总和4篇指南,总结出脑卒中护理相关的高级别证据52条。在此基础上,课题组结合前期现况调研,参考郭燕红等主编的《脑卒中专科护理》,讨论形成上海市老年医疗护理机构脑卒中护理质量评价指标体系初稿。3、通过2轮德尔菲法专家咨询,最终构建了《上海市老年医疗护理机构脑卒中护理质量评价指标体系》,包括指标名称、指标考核内容和考核方法。该指标体系涵盖脑卒中急性期到康复期护理全程,共29项,同时,附有部分标准操作流程和评估工具。4、实证研究表明,本研究所构建的脑卒中护理质量评价指标体系临床适宜可行,有利于指导临床护理和管理工作。同时,试点机构应用表明:借助脑卒中护理质量评价指标体系,实施护理质量控制,可达到“以评促改”,改善卒中患者的自理能力与肢体功能,患者平均住院天数由实施前的(98.69±15.72)缩短至实施后的(90.73±12.25)天,差异有统计学意义(p0.05);患者人均住院总费用无统计学差异(p0.05),但实施脑卒中单病种护理质控后,患者的日均护理费用由质控前的(27.18±4.54)元减少为(25.16±3.68)元,差异有统计学意义(p0.05)。研究结论:1、本研究通过文献回顾、现况调研、循证研究以及专家咨询构建了上海市老年医疗护理机构脑卒中护理质量评价指标体系,该质量评价指标体系涵盖脑卒中急性期到康复期护理全程,共29项指标。2、实证研究表明,本研究所构建的脑卒中护理质量评价指标体系临床适宜可行,可实施性强,各条目评分区分度好,有利于指导临床护理和管理工作。在老年医疗护理机构实施脑卒中单病种护理质量控制,可提升脑卒中患者自理能力,改善其肢体功能,减少患者住院天数,降低脑卒中患者护理费用,有效控制护理不良事件及相关并发症的发生,该质量评价体系临床适宜可行。
[Abstract]:Research purposes: Aiming at the status of the Shanghai city elderly medical care nursing of patients with stroke, "construction of Shanghai city of quality and nursing of elderly health care institutions stroke evaluation index system", and the evaluation index system of the quality of clinical validation studies, in order to improve the medical care institutions of Shanghai City elderly stroke nursing quality, improve patient outcomes stroke, provide the basis for the efficient use of health care resources. Methods: in the nursing for the old Shanghai City Hospital (medical), basic stroke care in research community health service centers and set the elderly health care beds Comprehensive Hospital of three elderly medical care institutions on clinical nursing path for single disease guided by evidence-based nursing research, preliminary construction of Shanghai city of quality nursing care for the elderly medical care institutions stroke evaluation index system; then through two rounds of expert Delphy Consultation, establish the evaluation index system of nursing quality for the elderly health care institutions for stroke in Shanghai city in Shanghai city. The elderly nursing management quality control inspection center of a nursing home for the elderly within the scope of the pilot, the empirical research on the evaluation index system of the quality, in order to verify the validity and feasibility of the clinical research results: 1, the status. Research shows that: at present, in the city of Shanghai elderly health care institutions in elderly patients with stroke is aging, patients over 80 years old in 2015 accounted for elderly health care institutions were 55.39% of the total number of stroke patients; the female patients than male, accounting for 55.40%; brain hospital stay between 10~637 days in patients with stroke; assessment agencies the activities of daily living ability of patients with stroke, neurological function assessment and nursing assessment of the implementation of different.2, according to evidence-based methods, through the retrieval system and guide Quality evaluation, finally 20 articles were included, including 10 systematic reviews, 6 pieces of evidence collection and 4 guide, summed up the nursing of stroke high level of evidence related to the 52. On this basis, combined with the previous research status, referring to Guo Yanhong editor of the "stroke secondary nursing department", to discuss the formation of Shanghai City, the quality of nursing care for the elderly medical care institutions stroke evaluation index system of the draft.3, through 2 rounds of Delphi method, set up "Shanghai city of quality nursing care for the elderly medical care institutions stroke evaluation index system", including the index name index, evaluation content and evaluation methods. The index system covers acute stroke to rehabilitation nursing, a total of 29, at the same time, a part of the standard operating procedures and assessment tools.4, the empirical study shows that the construction of the nursing quality evaluation index system for clinical stroke is feasible and advantageous To guide the clinical nursing and management. At the same time, show that the application of the pilot institutions: with the evaluation index system of nursing quality of cerebral stroke, nursing quality control, can achieve the "assessment and reform", improve the self-care ability of patients with stroke in patients with limb function, the average hospitalization days before the implementation of the (98.69 + 15.72) to shorten the implementation after the (90.73 + 12.25) days, the difference was statistically significant (P0.05); per capita total hospitalization expenses of patients no significant difference (P0.05), but the implementation of single disease nursing quality after stroke, the average daily cost of patients by nursing quality control before (27.18 + 4.54) yuan (25.16 + 3.68) to reduce the yuan. The difference was statistically significant (P0.05). Conclusions: 1 in this study, through literature review, current research, evidence-based research and expert consultation to construct the evaluation index system of nursing quality for the elderly health care institutions for stroke in Shanghai City, the quality evaluation index system To cover the acute stage of stroke rehabilitation nursing course, a total of 29 indicators of.2, the empirical study shows that the construction of the nursing quality evaluation index system for clinical stroke is feasible and easy to implement. Each item is rated partition indexing, to guide the clinical nursing and management. The implementation of the stroke in the elderly the medical care of single disease nursing quality control, enhance self-care ability of patients with stroke, improve the limb function, reduce hospitalization days, reduce the cerebral stroke patients nursing cost, effective control of nursing adverse events and related complications, the quality evaluation system of clinical feasible.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.74

【参考文献】