Development and validation of process indicators of the quality of nursing care for the elderly
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Abstract
Introduction: Quality indicators are important for service management. However, in primary care, there is a shortage of indicators specifically regarding the elderly population. Objective: To build and validate process indicators of the quality of nursing care for the elderly. Methods: This is a methodological research, and the steps are based on proposals from the National Database of Nursing Quality Indicators and the Agency for Healthcare Research and Quality. The indicators were evaluated according to the criteria of face validity, terminology, necessity, content validity, reliability, viability, utility, and usability. Nine nurses participated in the expert panel, including professionals who provided primary care assistance, researchers in the area of health care for the elderly, and members of Brazilian health-related organizations. The Adequacy Method developed by Research and Development at the University of California Los Angeles was used. Data were analyzed using the median, Content Validity Index, and Kappa. Results: Twenty-two indicators were validated. All measures were considered appropriate, with content validity, and reached an agreement on terminology and necessity. Of the 22 indicators, only four were considered unavailable and impractical to collect. Thirteen indicators were not considered useful for determining the reception of financial incentives. In the assessment of usability to compare public reports, six indicators had relatively low scores. Conclusion: Indicators can contribute to monitoring the quality of care for the elderly, identifying opportunities for improvement in actions performed by nurses in primary care.
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World Health Organization (WHO). OECD. International Bank for Reconstruction and Development. Delivering quality health services A global imperative for universal health coverage. Geneva: WHO, 2018.
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-Dewan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):E1196-252. https://doi.org/10.1016/S2214-109X(18)30386-3
Best M, Neuhauser D. Joseph Juran: overcoming resistance to organisational change. Qual Saf Health Care. 2006;15(5):380-2. https://doi.org/10.1136/qshc.2006.020016
Donabedian A. The quality of care: how can it be assessed? 1988. Arch Pathol Lab Med. 1997;121(11):1145-50.
National Quality Forum (NQF). Phrase book: a plain language guide to NQF jargon. Available from: http://public.qualityforum.org/NQFDocuments/Phrasebook.pdf.
Australian Commission on Safety and Quality in Health Care (ACSQHC). Practice-level indicators of safety and quality for primary health care specification. Sydney: ACSQHC, 2012.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Manual instrutivo: anexo: ficha de qualificação dos indicadores. Brasília: Ministério da Saúde, 2012.
Burston S, Chaboyer W, Gillespie B. Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. J Clin Nurs. 2014;23(13-14):1785-95. https://doi.org/10.1111/jocn.12337
National Quality Forum (NQF). National voluntary consensus standards for nursing sensitive care: an initial performance measure set. Available from: http://www.qualityforum.org/Publications/2004/10/Nursing_Sensitive_04_full.aspx.
National Database of Nursing Quality Indicators (NDNQI). NDNQI Nursing-Sensitive Indicators. Available from: https://nursingandndnqi.weebly.com/ndnqi-indicators.html.
Agency for Healthcare Research and Quality (AHRQ). Quality indicator measure development, implementation, maintenance, and retirement. Rockville: AHRQ, 2011.
Galvão CM, Mendes KDS, Silveira RCCP. Revisão integrativa: método de revisão para sintetizar as evidências disponíveis na literatura. In: Brevidelli MM, Sertório SCM. Trabalho de conclusão de curso: guia prático para docentes e alunos da área da saúde. São Paulo: Iátrica, 2010; p.105-26.
Fawcett J, Desanto-Madeya S. Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. EUA: Davies Company, 2012.
Dias FA, Gama ZAS, Tavares DMS. Primary health care to the elderly: a conceptual model of nursing. Cogitare Enferm. 2017;22(3):e53224. http://dx.doi.org/10.5380/ce.v22i3.53224
Brasil. Laboratório de Informações em Saúde (LIS). Instituto de Comunicação e Informação em Ciência e Tecnologia (ICICT). Fundação Oswaldo Cruz. PROADESS: avaliação de desempenho do sistema de saúde brasileiro: indicadores para monitoramento: relatório final. Rio de Janeiro: FIOCRUZ, 2011.
National Quality Forum (NQF). Measure evaluation criteria. Available from:http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/2013_Measure_Evaluation_Criteria_and_Guidance_on_Evaluation.aspx
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, Lacalle JR, Lázaro P, et al. The RAND/UCLA Appropriateness Method user's manual. Arlington: Rand, 2001.
Viacava F, Ugá MAD, Porto S, Laguardia J, Moreira RS. Evaluation of performance of health systems: a model for analysis. Cienc Saude Coletiva. 2012;17(4):921-34. http://dx.doi.org/10.1590/S1413-81232012000400014
Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27(2):94-111. https://doi.org/10.1093/swr/27.2.94
Gama ZAS, Saturno-Hernández PJ, Ribeiro DNC, Freitas MR, Medeiros PJ, Batista AM, et al. Development and validation of indicators for best patient safety practices: the ISEP-Brazil Project. Cad Saude Publica. 2016;32(9):e00026215. http://dx.doi.org/10.1590/0102-311X00026215
Brasil. Resolução Nº 466, de 12 de dezembro de 2012. Revolve Aprovar as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Available from: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf.
Betz CL, Cowell JM, Lobo ML, Craft-Rosenberg M. American Academy of Nursing Child and Family Expert Panel Health Care Quality and Outcomes Guidelines for Nursing of Children and Families: phase II. Nurs Outlook. 2004;52(6):311-6. http://dx.doi.org/10.1016/j.outlook.2004.10.003
Carlfjord S, Lindberg M. Asthma and COPD in primary health care, quality according to national guidelines: a cross-sectional and a retrospective study. BMC Fam Pract. 2008;9:36. http://dx.doi.org/10.1186/1471-2296-9-36
Lemley KB, Marks B. Patient satisfaction of young adults in rural clinics: policy implications for nurse practitioner practice. Policy Polit Nurs Pract. 2009;10(2):143-52. http://dx.doi.org/10.1177/1527154409341882
Hasna F, Hundt GL, Al-Smairan M, Alzaroo S. Quality of primary nursing care for Bedouin in Jordan. Int J Nurs Pract. 2010;16(6):564-72. http://dx.doi.org/10.1111/j.1440-172X.2010.01882.x
McIlrath C, Keeney S, McKenna H, McLaughlin D. Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study. J Adv Nurs. 2010;66(2):269-81. http://dx.doi.org/10.1111/j.1365-2648.2009.05140.x
Davies P, Wye L, Horrocks S, Salisbury C, Sharp D. Developing quality indicators for community services: the case of district nursing. Qual Prim Care. 2011;19(3):155-66.
Rivas FJP, García JMS, Arenas CM, Lagos MB, López MG. Implementation and evaluation of the nursing process in primary health care. Int J Nurs Knowl. 2012;23(1):18-28. http://dx.doi.org/10.1111/j.2047-3095.2011.01199.x
Roth CP, Ganz DA, Nickles L, Martin D, Beckman R, Wenger NS. Nurse care manager contribution to quality of care in a dual-eligible special needs plan. J Gerontol Nurs. 2012;38(7):44-54. http://dx.doi.org/10.3928/00989134-20120606-10
Dias FM. Fichas de informação dos indicadores de qualidade da assistência de enfermagem ao idoso na atenção primária. Draft Version. Cambridge: Harvard Dataverse, 2019. Available from: https://doi.org/10.7910/DVN/W3YEYA
Flôres GMS, Weigelt LD, Rezende MS, Telles R, Krug SBF. Gestão pública no SUS: considerações acerca do PMAQ-AB. Saúde Debate. 2018;42(116):237-47. http://dx.doi.org/10.1590/0103-1104201811619
Kotter T, Blozik E, Scherer M. Methods for the guideline-based development of quality indicators–a systematic review. Implement Sci. 2012;7:21. http://dx.doi.org/10.1186/1748-5908-7-21
Medeiros RKS, Ferreira Júnior MA, Pinto DPSR, Vitor AF, Santos VEP, Barichello E. Pasquali’s model of content validation in the Nursing researches. Rev Enf Ref. 2015;4(4):127-35. http://dx.doi.org/10.12707/RIV14009
Alexandre NMC, Gallasch CH, Lima MHM, Rodrigues RCM. Reliability in the development and evaluation of measurement instruments in the health field. Rev Eletr Enf. 2013;15(3):802-9. https://doi.org/10.5216/ree.v15i3.20776
Krauzer IM, Karal A, Bordignon M, Trindade LL. Records of nursing from the perspective of an integrative review. J Nurs Health. 2015;5(1):68-79.
Caçador BS, Brito MJM, Moreira DA, Rezende LC, Vilela GL. Being a nurse in the family health strategy programme: challenges and possibilities. Rev Mineira Enferm. 2015;19(3):612-9. http://www.dx.doi.org/10.5935/1415-2762.20150047
Lima KWS, Antunes JLF, Silva ZP. Perception of managers on the use of indicators in health services. Saude Soc. 2015;24(1):61-71. http://dx.doi.org/10.1590/S0104-12902015000100005