| Backgroud:Providing targeted medical care service for the elderly is based upon comprehensive and scientific evaluation.As disease and functional status change,the elderly need to be referred to different medical or care facilities.But at present,different medical care institutions in China use different assessment tools,resulting in the lack of comparability.In the context of the cooperation of medical and nursing institutions,we need a set of comprehensive and standardized assessment tool to unify the assessment for the elderly in different institutions,so as to understand and compare the health and functional status of the elderly in different institutions during the inter-institutional referral.CARE is a set of standardized and comprehensive assessment tool,which can carry on the continuous assessment and record in accordance with the need of care,is conducive to improving nursing service,strengthening information integration among different medical institutions such as hospitals,nursing institutions and community health service centers,and promoting a people-oriented health service system.However,at present,there are little research exploring the inter-evaluator reliability among doctors,nurses and caregivers in nursing institutions when using CARE as an assessment tool.In the meanwhile,in recent years,little research has been done on the impact of health and functional status of the elderly on duration of care.Therefore,this study was conducted to develop the Chinese version of CARE,exploring its reliability and validity,and to discuss the influencing factors of the duration of care.Objective:(1)To introduce the Chinese version of CARE and to develop a set of assessment tool that suitable for Chinese national conditions,which can be used to assess the comprehensive needs of integrated medical and nursing services,and the reliability and validity of its application in Chinese nursing institutions were explored.(2)CARE was applied to conduct comprehensive assessment of the elderly in nursing institutions,and to analyze their health function status and care needs.On this basis,we explored the influencing factors of duration of care for the elderly,to provide some references for the establishment of referral and classification for duration of care among different institutions for the elderly,in order to support continuous nursing care services in the future.Methods:Referring to the CARE assessment tool developed by the US,the final assessment tool in this study was determined through the authorization and acquisition of the scale,translation and synthesis,expert review,modification and debugging,and preliminary test.From January to April 2018,this study included the elders aged ≥60 years in a nursing institution from Shunyi District in Beijing,by using the purpose sampling method.5 trained and qualified assessors,including 1 doctor,1 nurse and 3 caregivers in the nursing institution,assessed the elderly.The data was collected by using the APP on mobile phone.The assessment was administered in two samples.Sample 1 included 30 elders ranging from 60 to 97 years,whose average age was(82.567±6.372)years,setting for examining the interrater reliability,test-retest reliability and internal consistency.Sample 2 included 239 elders(119 women and 120 men),whose age ranged from 60 to 106 years,with an average age of(82.301±12.465)years,for the purpose of testing the construct-related validity and criterion-related validity with 6 standard scales,including IADL,MMSE,BI,GDS,VAS and EQ-5D.After collecting 239 elders in sample 2,we identified the influencing factors of duration of care,by using the principal component analysis and multivariable ordered logistic regression model.Results:(1)The CARE scale was divided into 20 dimensions for analysis.In the CARE total scale and at each dimension level,the interrater reliability of the five evaluators(1 doctor,1 nurse,3 caregivers with primary school education),represented by intra-group correlation coefficient(ICC),were 0.945～1.000,respectively.Among them,the ICC value between doctors and nurses were 0.945-1.000,between doctors and 3 nurses were 0.945-1.000,between nurses and 3 nurses were 0.985-1.000,and between 3 caregivers with primary school education were 0.965-1.000.The results showed the reliability of the evaluators among doctors,nurses and caregivers were good.On the CARE total scale and the level of 20 dimensions,the test-retest reliability(after a one-week interval)were 0.842-1.000,and the internal consistency reliability were 0.717-1.000,respectively,both of which had good reliability levels.The criterion-related validity showed high correlations of its relevant dimensions with IADL,MMSE,BI,GDS,VAS and EQ-5D(r=0.802-0.998,all p<0.001).(2)The average duration of care required by the elderly per 24 hours was expressed as 0(0,179.83)min/24h by the median and quartile interval,and the average duration of care was 93.56 min/24h.There were 119(49.79%)elders whose duration of care was 0min/24h,63(26.35%)elders whose duration of care was<120min/24h,43(17.99%)elders whose duration of care was 120-360min/24h,and 14(5.86%)elders duration of care was>360min/24h.The results of multivariable ordered logistic regression model analysis showed that age,self-care ability and muscle strength were the key factors affecting the length of care for the elderly in nursing homes(all p<0.01).Conclusions:The reliability and validity of the Chinese version of CARE scale are both good.Doctors,nurses and caregivers,after unified training,all can use CARE to effectively evaluate the health and functional status for the elderly.Therefore,CARE can be used as a comprehensive assessment tool for the elderly in nursing institutions in China.In addition,it is suggested that when grading the health function status and care duration of the elderly,and providing care services for the elderly,the nursing institutions should give priority to the elderly who are not elderly,have poor self-care ability and decline in muscle strength,so as to rationally allocate medical care resources. |
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