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Quality Indicators for Older Persons’ Transitions in Care: A Systematic Review and Delphi Process

Published online by Cambridge University Press:  03 June 2021

Kaitlyn Tate
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta
Sarah Lee
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta
Brian H Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta
Garnet E Cummings*
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta
Jayna Holroyd-Leduc
Affiliation:
Foothills Medical Centre, University of Calgary, Calgary, Alberta
R Colin Reid
Affiliation:
School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, British Columbia
Rowan El-Bialy
Affiliation:
Schulich School of Business, York University, Toronto, Ontario
Jeffrey Bakal
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta
Carole A Estabrooks
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta
Carol Anderson
Affiliation:
Alberta Health Services, Edmonton, Alberta
Greta G Cummings
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta
*
Corresponding Author: La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Greta G. Cummings, Ph.D., R.N., F.A.A.N., F.C.A.H.S. Faculty of Nursing University of Alberta, 5-110 Edmonton Clinical Health Academy 11405 87 Avenue Edmonton, Alberta Canada T6G 1C9. (gretac@ualberta.ca)

Abstract

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

Résumé

Résumé

Nous avons identifié des indicateurs de qualité (IQ) liés aux soins offerts lors des transitions de personnes âgées (> 65 ans). Par une revue systématique, nous avons catalogué les IQ associés aux transitions de soins de personnes âgées qui étaient transférées entre des établissements de soins continus, ainsi qu’entre ceux-ci et des établissements de soins actifs, et inversement. Deux cycles d’enquêtes Delphi ont été effectués. Des experts ont classé la pertinence, la faisabilité et la solidité scientifique des IQ. Notre comité directeur a examiné les IQ concernant la faisabilité de leur capture dans les bases de données administratives canadiennes. Notre recherche a mené à 326 IQ provenant de 53 sources. Un total de 38 indicateurs ont été sélectionnés en considération de la faisabilité de ces mesures dans la pratique actuelle. La plus grande proportion des indicateurs visait les services d’urgence (47 %) et l’efficacité selon les domaines de qualité de l’Institute of Medicine (IOM) (39,5 %). Les indicateurs présentant la meilleure faisabilité étaient ceux liés aux résultats. Notre étude met en évidence un développement insuffisant d’IQ standardisés pour les transitions en pratique, ainsi que des limites dans les systèmes de documentation actuellement en accès libre pour l’obtention de données pertinentes et cohérentes.

Type
Article
Copyright
© Canadian Association on Gerontology 2021

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