【摘要】 目的 评估基于老年照护临床导师制（aged care clinical mentoring,ACCM）培训对养老机构照护人员的组织质量改进与维持能力及工作满意度的影响。方法 于2024年1～7月，采用分层整群随机对照试验设计，以深圳市16所养老机构为随机化单位分为干预组与对照组各8所；干预组在常规培训基础上接受为期6个月的ACCM培训，对照组仅接受常规培训。采用组织质量改进与维持能力量表（Shortell’s organization and management survey）和明尼苏达满意度简表（Minnesota satisfaction questionnaire in short form,MSQ-20）评估2组养老机构照护人员干预前后的组织质量改进与维持能力和工作满意度。采用多重插补意向性治疗，并以广义估计方程（机构为簇、稳健标准误）评估时间、组别及时间×组别交互效应，调整机构性质、性别、年龄和工作职位等协变量。利用线性混合效应模型（机构与个体随机截距）进行敏感性分析。结果 干预组纳入的8所养老机构照护人员共计331人，研究中失访22人（失访率6.65%）；对照组纳入的8所养老机构照护人员共计249人，研究中失访30人（失访率12.01%）。在组织质量改进与维持能力方面，广义估计方程结果显示组别主效应及时间×组别交互效应差异有统计学意义（P<0.001）。在工作满意度方面，干预后2组差异无统计学意义；广义估计方程结果提示时间×组别交互效应达到统计学意义（β=1.501,P=0.034），但该结果在线性混合效应模型中未保持显著（P=0.069）。结论 ACCM培训可有效提升养老机构照护人员的组织质量改进与维持能力，为我国养老照护质量改进提供了可推广的实证依据，但其对工作满意度的提升作用有限，未来应结合老年人健康结局及随访进行长期验证。更多还原

【Abstract】 Objective To evaluate the impact of training based on the aged care clinical mentoring(ACCM) program on organizational quality improvement and maintenance capabilities as well as job satisfaction among caregivers in nursing homes. Methods In January to July 2024, a stratified cluster randomized controlled trial design was adopted, with 16 nursing homes in Shenzhen randomly assigned as units to either the intervention group(8 homes) or the control group(8 homes). The intervention group received ACCM training over six months in addition to routine training, while the control group received routine training only. The Shortell’s organization and management survey and the Minnesota satisfaction questionnaire in short form(MSQ-20) were used to assess organizational quality improvement and maintenance capabilities and job satisfaction among caregivers in both groups before and after the intervention. Multiple imputation was applied for intention-to-treat analysis, and generalized estimating equations(with nursing homes as clusters and robust standard errors) were used to evaluate the effects of time, group, and time×group interaction, adjusting for covariates such as institution type, gender, age, and job position. Sensitivity analysis was conducted using linear mixed-effects models. Results A total of 331 caregivers from 8 nursing homes were included in the intervention group, with 22 lost to follow-up(loss rate 6.65%). The control group included 249 caregivers from 8 nursing homes, with 30 lost to follow-up(loss rate 12.01%). Regarding organizational quality improvement and maintenance capabilities, generalized estimating equations showed statistically significant main effects of group and time×group interaction(P<0.001). In terms of job satisfaction, no statistically significant difference was observed between the two groups after the intervention. Generalized estimating equations indicated a statistically significant time×group interaction effect(β=1.501,P=0.034), but this result was not sustained in the linear mixed-effects model(P=0.069). Conclusion ACCM training can effectively enhance the organizational quality improvement and maintenance capabilities of caregivers in nursing homes, providing scalable empirical evidence for improving the quality of aged care in China. However, its effect on improving job satisfaction is limited, and future studies should incorporate long-term validation with health outcomes of older adults and follow-up assessments.更多还原