Construction Of A Sensitive Quality Indicator System For Home Enteral Nutrition Care For Patients With Dysphagia In Stroke

ObjectiveBased on the Donabedian "structure-process-outcome" theory model,a scientific,reliable and rational index system for sensitive quality of home enteral nutrition care for stroke patients with dysphagia were constructed to provide a scientific,systematic and quantitative basis for judging and monitoring the quality of home enteral nutrition care.Methods1.The evidence-based analysis and evidence translation were conducted through literature review to provide a basis for the construction of a sensitive quality index system for home enteral nutrition care for patients with dysphagia in stroke.2.The actual needs of stroke patients and carers with dysphagia were identified through semi-structured interviews,and the index entries were further revised and refined.3.The content,meaning,calculation formula and collection method of sensitive quality indicators of home enteral nutrition care for stroke patients with dysphagia were initially formulated by summarizing of group discussion method and organizing of extracted indicators contents.4.Two rounds of consultation were conducted with 24 experts through the expert consultation method to collect their suggestions and opinions,add,delete and modify the indicators,and finally establish a sensitive quality indicator system for home enteral nutrition care for stroke patients with dysphagia.5.Each sensitive indicator in the second round of consultation was weighted by the hierarchical analysis method and tested for consistency.Results1.Initially,1086 relevant papers were obtained,and 16 papers were finally included after initial screening and re-screening,including 1 paper of class IIA(6.25%),4 papers of class IIIA(25.00%),1 paper of class IIIB(6.25%),2 papers of class IVA(12.50%),4papers of class IVB(25.00%),3 papers of class VA(18.75%)and 1 paper of class VB(6.25%).After combining the results of semi-structured interviews,extracting the content of indicators at each level and face-to-face discussions among the group members,a preliminary system of sensitive quality indicators for home enteral nutrition care for patients with dysphagia in stroke was developed,including 3 primary indicators,8 secondary indicators and 41 tertiary indicators.2.Correspondence results:(1)Higher degree of experts’ positivity: the effective recovery rates of the two rounds of correspondence questionnaires were 87.5% and 100.0%;(2)Higher degree of experts’ authority: the Cr values of the two rounds of correspondence questionnaires were 0.867 and 0.876;(3)Higher degree of experts’ opinion concentration: in the results of the two rounds of correspondence,the mean index importance scores ranged from 3.238 to 5.000 and 3.905 to 5.000,with standard deviations of 0.000 to 1.554 and0.000 to 0.831,and full score ratios of 0.286 to 1.000 and 0.333 to 1.000;(4)Higher degree of experts’ opinion coordination: the degree of coordination of experts’ opinions was high:the W values were 0.149 to 0.226 and 0.151 to 0.238 in the results of the two rounds of correspondence.3.Indicator weights were calculated: the weights of primary indicators were structure(0.2500),process(0.5000)and outcome(0.2500),and the weights of secondary indicators were instrumentation(0.0625),education and training(0.1875),swallowing management(0.0988),nutrition management(0.2453),health education(0.1560),adverse events(0.0500),patient outcomes(0.1000),and outcome evaluation(0.1000).Among the 33 tertiary indicators,the pass rate of HEN knowledge and skills assessment for caregivers(0.1125),the participation rate of patients and caregivers in the multidisciplinary collaborative development of HEN protocols(0.0669),the knowledge rate of secondary stroke prevention(0.0669),the implementation rate of dynamic assessment of swallowing function(0.0518),the efficiency rate of swallowing function improvement(0.0490),the knowledge rate of secondary stroke prevention(0.0490),the implementation rate of nutritional risk screening(0.0454),the dispensary rate of controlled enteral nutrition infusion pump(0.0417),the implementation rate of regular training of multidisciplinary nutrition support team(0.0375),and the implementation rate of HEN knowledge and skills training of caregiver(0.0375)were ranked in the top 10.ConclusionThrough the construction of this study,we had identified 32 sensitive quality indicators for home enteral nutrition care in stroke patients with dysphagia,covering eight aspects:instrumentation,education and training,swallowing management,nutrition management,health education,adverse events,patient outcomes,and outcome evaluation.These indicators were scientific,reasonable and reliable,which is conducive to strengthening the standardization,specialization and standardization of family intestinal care of patients with stroke dysphagia.At the same time,these indicators also provided a reference for scientific monitoring,evaluation and improvement of the quality of enteral nutrition nursing of patients with stroke dysphagia in the future,so as to promote the continuous improvement of nursing quality and improve the level of nursing management.