Study On Establishing The Nursing-sensitive Quality Indicators In The Hip Fracture On The Basis Of Evidence-based

Objective:The research applied the method of evidence-based medicine,to find out the evidence that affect the quality of care and quality assessment of patients with hip fractures.To formulate a scientific,practical,sensitive quality index of hip fracture,providing the basis for the evaluation and monitoring of the quality of care for patients with hip fracture.At the same time,enhancing the nursing awareness for the adverse outcome of patients that to provide safety guarantee for patients with hip fracture.Methods:1.Literature research: We searched literature published Medline,Science Direct,Chinese biomedical literature database(CBM),CNKI,Wanfang database,and guide web site National Guideline Clearinghouse(NGC),to seek literature about the hip fracture nursing quality evaluation.According to the classification method of Australia JBI based evidence center health care card set(2010),classified the level of evidence of literature,and summarized the evaluation indicators of nursing quality of hip fracture.2.System evaluation: We searched literature published Medline,Library searched Cochrane,EMbase,Chinese biomedical literature database(CBM),CNKI and Wanfang database,to find out the factors that influence the nursing outcomes of hip fracture patients,and use Rev Man 5.3 software to quantitatively analysis data.3.Group discussion: The group of experts analyzed and sorted out the nursing quality concerning nursing process,nursing outcomes and nursing sensitivity indexes of hip fracture.To discuss the items meaning,calculation formula and the method of collecting information.Studying out sensitivity index system of nursing quality of hip fracture.4.Delphi: The Delphi expert consultation method was used to evaluate the indexes,the calculation formula and the method of data collection,and to establish the nursing quality sensitivity index of hip fracture.Using expert positive coefficient,authority coefficient,variation coefficient and the coordination coefficient,statistical analysis of the consultation results.Result1.Through searching literature found out 24 studies,including 3 guidelines,19 literature,2expert consensus.Summarize the process and outcomes indexes,relating to the quality evaluation of nursing of hip fracture.Has not yet found the index system of nursing quality evaluation of hip fracture.For further construction of hip fracture nursing quality sensitivity index to provide evidence support and theoretical reference.2.Through searching literature and evaluating the quality of literature,50 articles were included in the Meta-analysis,including 25 cohort studies and 25 case-control studies.We analyze risk factors which can influence the patients' nursing outcomes;3.A comprehensive summary of the evidence collected,building the 20 items hip fractures nursing quality sensitive indicators,including index connotation,calculation formula,the numerator and denominator of interpretation,data collection method.The positive coefficient of consultation were 80% and 100%(> 70%),the expert authority coefficient was 0.83(> 0.7).After 2 rounds of expert consultation the coefficient of variation of the importance of each indicator is 0.05~0.22,calculating the variation coefficient formula of rationality is 0.06~0.17,in the data collection method effectiveness coefficient is0.04~0.21(< 0.3).Conclusion In this study,using evidence-based theory,sorted evidences through the scientific evaluation system analysis.The construction of nursing quality sensitivity of an index system including 20 items of hip fracture,established the connotation of each index,calculation method and data collection method.Providing the evidence for clinical nursing staff and improving the quality of nursing,to reduce hip fracture patients mortality and disability rate.But the index system needs to be further clinical trial application.