Development of Service Quality Indicators for Health Care Combined with Nursing Home

doi:10.12114/j.issn.1007-9572.2018.00.208

Abstract

Abstract: Background　With an increasingly aging population in China，the model of integrated elderly care and medical services has become a trend.It will greatly alleviate the pressure of old-age care in China，but there is no clear and unified evaluation standard for the service quality of medical and nursing homes．Objective　To construct an evaluation index system of Service Quality Indicators for Health Care Combined with Nursing Home．Methods　Based on the “structure-process-result” framework，a quality evaluation index system framework was formulated through field research，related policies and literature and Delphi method to build a preliminary item pool of index system of Service Quality Indicators for Health Care Combined with Nursing Home from October 2017 to March 2018.The reliability of expert consultation was analyzed by using positive coefficient，authority coefficient （Cr） and harmony coefficient of experts.The importance mean score，coefficient of variation （CV） and full score was used to evaluate the entries，and the weight of each index was determined by the weight method of percentile．Results　The effective questionnaire recovery rates for two rounds of expert consultation were 91.6% and 100.0%，respectively，and authority coefficients were 0.83 and 0.84，respectively.Harmony coefficients （W） of level two and three indicators in the first round of expert consultation were 0.116 and 0.137，respectively，and in the second round 0.137 and 0.321，respectively （P<0.05）．The evaluation index system of Service Quality Indicators for Health Care Combined with Nursing Home was determined in the end，including 3 first-level indicators，14 second-level indicators，and 72 third-level indicators．Conclusion　Index system of Service Quality Indicators for Health Care Combined with Nursing Home is initially established，providing quantitative basis for service quality evaluation and continuous improvement for health care combined with nursing homes.

Key words: Nursing home, Delphi technique, Nursing evaluation research

摘要： 背景　在我国人口老龄化日益严重的背景下，“医养结合”的养老模式即医养院，已成为趋势，其将极大缓解我国的养老压力，而目前针对医养院服务质量暂无明确统一的评价标准。目的　构建医养院服务质量评价指标体系。方法　2017年10月—2018年3月，通过实地调研、研究相关政策和文献、德尔菲（Delphi）专家咨询法，构建以“结构-过程-结果”为理论框架的医养院服务质量评价指标体系。采用专家积极程度、专家权威系数（Cr）、专家意见的协调程度分析专家咨询的可靠性，专家对条目的评价采用重要性得分均数、变异系数（CV）和满分率表示，采用百分权重法确定各指标权重。结果　两轮专家咨询的问卷有效回收率分别为91.6%和100.0%，Cr分别为0.83、0.84。第1轮专家咨询二级指标、三级指标的协调系数（W）分别为0.116、0.137，第2轮专家咨询二级指标、三级指标的W分别为0.137、0.321（P<0.05）。最终确定医养院服务质量评价指标体系，包括3项一级指标，14项二级指标，72项三级指标。结论　初步确立了医养院服务质量评价指标体系，为医养院服务质量的评价和持续改进等提供量化
依据。

关键词: 医养院, 德尔菲技术, 护理评价研究

DU Xiaofei,JING Liwei,WANG Qing, et al. Development of Service Quality Indicators for Health Care Combined with Nursing Home　[J]. Chinese General Practice, 2019, 22(2): 194-198. DOI: 10.12114/j.issn.1007-9572.2018.00.208.
杜晓菲,景丽伟,王晴等. 医养院服务质量评价指标体系的构建[J]. 中国全科医学, 2019, 22(2): 194-198. DOI: 10.12114/j.issn.1007-9572.2018.00.208.

References

［1］中华人民共和国民政部.2016年社会服务发展统计公报［R/OL］．（2017-08-03）［2017-11-06］．http：//www.mca.gov.cn/article/sj/tjgb/201708/20170800005382.shtml.
［2］吴宏洛.探索实行医养结合养老模式［N］．福建日报，2013-12-23（11）．
［3］谢红，王志稳，侯淑肖，等．我国养老服务需求现状及其长期照护护理服务策略［J］．中华护理杂志，2012，47（1）：14-16．DOI：10.3761/j.issn.0254-1769.2012.01.005.
XIE H，WANG Z W，HOU S X，et al．The status of elderly care service needs and long-term care services strategies in China［J］．Chinese Journal of Nursing，2012，47（1）：14-16．DOI：10.3761/j.issn.0254-1769.2012.01.005.
［4］中华人民共和国民政部.国办转发关于推进医疗卫生与养老服务相结合的指导意见［EB/OL］．（2015-11-23）［2017-11-06］．http：//www.mca.gov.cn/article/zwgk/mzyw/201511/20151100877458.shtml.
［5］HAKKARAINEN T W，AYOUNG-CHEE P，ALFONSO R，et al．
Structure，process，and outcomes in skilled nursing facilities：understanding what happens to surgical patients when they cannot go home.A systematic review［J］．J Surg Res，2015，193（2）：772-780．DOI：10.1016/j.jss.2014.06.002.
［6］PAQUETTE-WARREN J，TYLER M，FOURNIE M，et al．The Diabetes Evaluation Framework for Innovative National Evaluations （DEFINE）：construct and content validation using a modified delphi method［J］．Can J Diabetes，2017，41（3）：281-296．DOI：10.1016/j.jcjd.2016.10.011.
［7］伍琳，孙艳杰.德尔菲法简介及在护理学中的应用现状［J］．护理研究，2015，29（10）：3599-3601．DOI：10.3969/j.issn.1009-6493.2015.29.006.
WU L，SUN Y J.Delphi method introduction and its appl ication status quo in “nursing science”［J］．Chinese Nursing Research，2015，29（10）：3599-3601．DOI：10.3969/j.issn.1009-6493.2015.29.006.
［8］曾光.现代流行病学方法与应用［M］．北京：北京医科大学中国协和医科大学联合出版社，1994：250-259.
ZENG G.Modern epidemiological methods and applications ［M］．Beijing：Peking Union Medical College Press Union，Beijing Medical University，1994：250-259.
［9］EVANS B J W，ALLEN P M，WILKINS A J.A Delphi study to develop practical diagnostic guidelines for visual stress （pattern-related visual stress）［J］．J Optom，2017，10（3）：161-168．DOI：10.1016/j.optom.2016.08.002.
［10］SHERET L，STEELE J A.Information literacy assessment keep it simple，keep it going［J］．Reference & User Services Quarterly，2013，52（3）：208-215.
［11］KABACI M J，CUDE B J.A Delphi study to identify personal finance core concepts and competencies of first-generation college students［J］．Fam Consum Sci Res J，2015，43（3）：244-258.
［12］DONABEDIAN A.The quality of care How can it be assessed［J］．JAMA，1988，260（12）：1743-1748.
［13］王立剑，凤言，王程.养老机构服务质量评价研究［J］．人口与发展，2017，23（6）：96-102.
WANG L J，FENG Y，WANG C.Evaluating the service quality of the nursing institution for the aged［J］．Population and Development，2017，23（6）：96-102.

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