基于专家德尔菲共识小组的辅助生活医疗和精神保健建议：共识声明。
Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel: A Consensus Statement.
机构信息
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill.
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill.
出版信息
JAMA Netw Open. 2022 Sep 1;5(9):e2233872. doi: 10.1001/jamanetworkopen.2022.33872.
IMPORTANCE
Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents' medical and mental health needs. No guidance exists to inform this care.
OBJECTIVE
To identify consensus recommendations for medical and mental health care in AL and determine whether they are pragmatic.
EVIDENCE REVIEW
A Delphi consensus statement study was conducted in 2021; as a separate effort, the extent to which the recommendations are reflected in practice was examined in data obtained from 2016 to 2021 (prepandemic). In the separate effort, data were from a 7-state study (Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, Texas). The 19 Delphi panelists constituted nationally recognized experts in medical, nursing, and mental health needs of and care for older adults; dementia care; and AL and long-term care management, advocacy, regulation, and education. One invitee was unavailable and nominated an alternate. The primary outcome was identification of recommended practices based on consensus ratings of importance. Panelists rated 183 items regarding importance to care quality and feasibility.
FINDINGS
Consensus identified 43 recommendations in the areas of staff and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care. To determine the pragmatism of the recommendations, their prevalence was examined in the 7-state study and found that most were in practice. The items reflected the tenets of AL, the role of AL in providing dementia care, the need for pragmatism due to the diversity of AL, and workforce needs.
CONCLUSIONS AND RELEVANCE
In this consensus statement, 43 recommendations important to medical and mental health care in AL were delineated that are highly pragmatic as a guide for practice and policy.
重要性
辅助生活（AL）是美国最大的住宅长期护理提供者，并且 AL 居民的发病率一直在上升。然而，AL 不是一个医疗保健环境，人们对居民的医疗和心理健康需求的担忧与日俱增。目前还没有指导意见来提供这种护理。
目的
确定 AL 医疗和心理健康护理的共识建议，并确定它们是否具有实际意义。
证据审查
2021 年进行了一项德尔菲共识声明研究；作为一项单独的工作，在 2016 年至 2021 年（大流行前）获得的数据中，检查了这些建议在实践中的反映程度。在单独的工作中，数据来自 7 个州的研究（阿肯色州、路易斯安那州、新泽西州、纽约州、俄克拉荷马州、宾夕法尼亚州、德克萨斯州）。19 名德尔菲专家组成员是公认的医学、护理以及老年人医疗、护理和长期护理管理、宣传、监管和教育方面的专家；痴呆症护理；以及辅助生活和长期护理管理、宣传、监管和教育。一名受邀者无法出席，并提名了一名替代者。主要结果是根据对护理质量和可行性的重要性的共识评分确定推荐做法。专家们对 183 项与护理质量相关的项目进行了重要性和可行性评估。
发现
共识确定了在员工和员工培训、护理和相关服务、居民评估和护理计划、政策和实践以及医疗和心理健康临床医生和护理等领域的 43 项建议。为了确定建议的实际意义，在 7 个州的研究中检查了它们的普遍性，并发现大多数都在实践中。这些项目反映了 AL 的原则、AL 在提供痴呆症护理方面的作用、由于 AL 的多样性而需要务实以及劳动力需求。
结论和相关性
在这项共识声明中，确定了 43 项对 AL 医疗和心理健康护理至关重要的建议，这些建议具有很高的实际意义，是实践和政策的指南。
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