Study On The Evaluation Of The Quality Of Care For The Medical-Nursing Combined Care Institutions-From Residents' Perspective

?Objectives? Exploring the quality appraisal elements based on residents' experience in mainland medical-nursing combined pension institutions.Establishing an evaluation framework of care quality from residents' perspective and designing a residents' experience evaluation questionnaire.Conducting a field test for the questionnaire and describing the status of residents' experience in Wuhan city.?Methods? Purposive sampling method was used to select subjects who were then involved in semi-structured in-depth interview.The data about residents' experience were category analyzed to explore the quality appraisal elements in medical-nursing combined pension institutions.The themes extracted from interviewing data were combined with the result of literature reviewing,policy studying and group discussion to establish an evaluation framework of care quality by expert consultation.Then a questionnaire was created based on the framework of quality care after group discussion.User acceptance testing and item analyzing were carried out to optimize the questionnaire.The reliability and validity of the questionnaire were tested by alpha reliability coefficient method and expert consultation.Field test for the questionnaire were conducted and the number of subjects is about 5-10 times of the items in residents' experience questionnaire.Using Epi Data3.1 and IBM SPSS20.0 to build database and enter data.Apply descriptive and deductive statistics methods for data analysis.Alpha = 0.05 was selected as inspection level in this study,and all data are bilateral inspected.?Results? We interviewed totally 21 elder residents in 4 pension institutions,6 themes are extracted from residents' experience,which including hardware facilities,personal quality and competence of nursing staff and caring process,living guarantee and human rights assurance,empathy for residents' dignity,privacy and spirit,conversion process between different levels of nursing care,equality when deal with conflicts among residents.These could be the quality concerns of residents that matter most.Totally 18 experts and 27 experts participated in our first round and second round expert consultation,respectively.The criterions of experts(Ca)are 0.911 and 0.926 respectively,the experts' familiarity degree(Cs)are 0.761 and 0.774 respectively,the experts' authority degree(Cr)are 0.836 and 0.850 respectively.Finally we established a care quality evaluation framework which including 5 first-level indicators namely tangible,reliability,assurance,empathy and continuity.14 second-level indicators and 46 third-level indicators are derived based on first-level indicators.The overall reliability of the questionnaire we created is 0.956,the split-half reliability is 0.922.The value of S-CVI(S-CVI/UA)and S-CVI(S-CVI/Ave)are used to evaluate content validity of the questionnaire,which are 0.87 and 0.988 respectively.We sent 205 copies of questionnaire and all of them were recovered in which 3 copies were invalid.The effective recovering rate is 98.537%.The total score of resident experience is 73~150(123.82±17.394).The highest to lowest score of the 5 dimensions are reliability,tangible,assurance,empathy,continuity.Residents have good experience on living environment,life assurance,staff uniform,have relatively bad experience on feedback and comments,hospice care,dietary and exercise facilities.Residents' overall experience,experience on tangible,empathy and continuity in public institutions is better than private institutions(P<0.05).Age,education level,marriage,income,the initiative to move in,the number of roommates,the degree of supporting from family members,the number of daughters and the ability to control urination are the factors which effects residents' experience(P<0.05).?Conclusions? Residents' experience are mainly reflected in the six aspects of tangible,reliability,assurance,empathy,continuity and fairness,but the experience about medical care in pension institutions needs further excavation.The purpose of talking with residents is to figure out the quality points that residents concerned about,thus could helping administrators improve quality of care.In addition,improving the wellness of residents should be the ultimate goal of quality management in pension institutions.In our study,the care quality evaluation framework was established by experts' consultation.Experts we invited are from different fields,such as educational institutions,hospitals,pension institutions,which makes the framework more compressive,systematic,and more controllable.The resident experience questionnaire can effectively evaluate and reflect the care quality of pension institutions after language acceptance test and field test.The result of the cross-sectional survey suggests that the construction on assurance,empathy and continuity needs to be improved in both public and private pension institutions.The hardware facilities in private institutions needs urgently configuration.In conclusion,the residents' experience questionnaire is of significant importance to develop and improve nursing care system of pension institutions in China.