Research On Model Of Subsiding High-quality Nursing Resources Based Integrated Urban Healthcare System

Background:The distribution of health resources is inequal.High-quality medical resources are concentrated in tertiary hospitals,resulting in patients are also concentrated in there.It leads to the problem of the difficult and expensive medical treatment.Guided by the ideology of the integration of health resources and the policy context of the construction of integrated urban healthcare system,the government has been committed to optimizing the structural layout of nursing resources,and promoting the subsiding of high-quality nursing resources.Thus,it can improve the equity and accessibility of high-quality of nursing resources,and drive patients to primary medical institutions.It is of great significance to explore the plan formulation,implementation and evaluation of that.At present,this kind of work in clinical practice is not standardized and lacks methodological basis.The quality of work can not be guaranteed.Model is a scientific method of thinking and operation.It is necessary to explore the model of subsiding high-quality nursing resources based integrated urban healthcare system.Therefore,it can provide the methodological guidance for clinical practice to carry out the work.Objectives:① To explore the main elements,their characteristics,and relationships of subsiding high-quality nursing resources based integrated urban healthcare system,and to form the model of subsiding high-quality nursing resources based integrated urban healthcare system.② To evaluate the completeness,clearance,applicability,feasibility and expected effectiveness of the model of subsiding high-quality nursing resources based integrated urban healthcare system.Methods:This study consisted of two parts.The first part was the study on the development of the model of subsiding high-quality nursing resources based integrated urban healthcare system.Three methods were used in sequence.① The theoretical analysis method was adopted to confirm the main elements,their relationships,and to form the theoretical framework of the model.②The literature analysis method was adopted.Based on the theoretical framework,the researchers extracted the information of characteristics of the main elements.The inductive method was used to analyze the information.It was designed to confirm some characteristics of the main elements,and to found some other characteristics needed further exploration.③ The purposive sampling and theoretical sampling were used to select 24 medical staffs who came from 8 provinces and cities,12 integrated urban healthcare systems,and 16 medical institutions.The semi-structured interview was conducted.Colaizzi’ s method of data analysis was used.It was designed to confirm the characteristics of the high-quality nursing resources,and the process of subsiding.Combined with the results of the three stages,the first draft of the model was formed.The second part was the study on the evaluation of the model.Two methods were used in sequence.① The method of Delphi consultation was adopted.According to convenience sampling,15 experts in the field of the subsiding high-quality nursing resources based integrated urban healthcare system were selected.They evaluated the completeness and clearance of the model.According to their opinions,the researcher modified the model.It formed the final draft of the model.② Cross-sectional survey was adopted.On the basis of the final draft of the model,the questionnaire was designed.The convenience sample was used to select 210 users of the model from seven administrative regions.They evaluated the applicability,feasibility and expected effectiveness of the model.Results:The first part:①The study formed the theoretical framework of the model.It included three main elements and their structures.②The researcher found the characteristics of the supplier,demander,demand of subsiding,decision-maker of subsiding,and evaluation.③ The researcher found the characteristics of high-quality nursing resources,summarizing three main themes.The researcher also found the characteristics of the process of subsiding,summarizing three main themes of the principle of subsiding,five main themes of the content of subs ding,and four main themes of the form of subsiding.Finally,the first draft of the model was formed.It included three main elements,their characteristics and relationships.Three main elements were the structure of subsiding,process of subsiding,and evaluation.The structure of subsiding included supplier,demander,high-quality nursing resources,the demand of subsiding,and the decision-maker of subsiding.The supplier was tertiary hospital characterized by the concentration of high-quality nursing resources.The demander was primary medical institutions characterized by insufficient high-quality nursing resources.The high-quality nursing resources were reflected in sufficient quantity,well-developed quality,safety and efficiency.The demand of subsiding included two aspects.The first one was the demand of the development of nursing.The second one was patients’ demand for nursing services in primary medical institutions.The decision-makers of subsiding were nursing managers from the supplier and the demander.The process of subsiding included the principles,contents and forms of subsiding.The principles included multidisciplinary collaborative team construction,multiple institutions participating in the coordination of the selection of supply and demand,and systematical thinking of variety of high-quality nursing resources.The contents included nursing human,material,financial,informational,and technical resources.The forms included dispatching support personnel,off-job learning,distance training,and combination of different forms.The evaluation included three layers.They were learning,behavior,and results.In the layer of learning,the work could improve nurses’ level of knowledge and skill.In the layer of behavior,the work could improve the service ability of nursing in primary medical institutions.In the result of layer,it could improve the overall service ability of primary medical institutions.The ordinal relationships among the three main elements reflected the whole process of subsiding.In the second part:①Two rounds of Delphi consultations were carried out.The coefficients of variation were 0.15 and 0.06.Kendall’s coefficients of concordance were 0.418 and 0.506.The expert authority coefficient was 0.92.The scores of the completeness and clearance were 4.47±0.50,4.73±0.44.The final draft of the model was formed.②The scores of the applicability,feasibility,and expected effectiveness were 4.50±0.61,4.38±0.67,and 4.35±0.67,respectively.Conclusion:The study formed the model of subsiding high-quality nursing resources based integrated urban healthcare system,including three main elements.They were the structure of subsiding,process of subsiding,and evaluation.According to the characteristics of the main elements,the nursing managers could select the high-quality of nursing resources,their contents and forms of subsiding.The ordinal relationships among three main elements reflected the whole process of subsiding.The model was in high level of the completeness,clearance,applicability,feasibility,and expected effectiveness.It can provide methodological guidance for the plan formulation,implementation,and evaluation of subsiding in clinical practice.Clinical empirical research of the model is still needed to be further studied.