| ObjectiveThe home care service started late in the Chinese community.In addition,a standardized service process was not established,and the quality monitoring system has not been sophisticated yet.Considering aspects influencing the quality of family nursing,this study tried to construct a set of home care quality indicators which appeals to Chinese,with the aim to improve the quality of home care services and provide reference for the relevant home care administrative departments.MethodsThe research paper was divided into three parts.Part ?: Framework formation of the evaluation index system of professional home care service quality.This part first depicts the key factors and links that affected the quality of home nursing service from the real level,and a framework of the indicator system was preliminarily constructed.Furthermore,the key factors and links that affected the quality of home nursing service from the expected level to complement the lack of real level was assessed through a meeting with experts regarding the formation of an initial framework.1.The impact of home care quality of the key factors and links from the real level were investigated through field research.Three community care centers in Shanghai were selected in this study.Furthermore,followed by 14 home care workers,conducted a participatory observation,recorded near 10 million words of field notes,and took more than 100 pieces of pictures.Content analysis was conducted to analyze the data.Finally,confirming first-level indicators 2,two indicators of the 10,the three indicators of the 38,made the corresponding indicators of content clearly.2.The key factors and links that affect the quality of home care service from the perspective of the level were analyzed via a semi-structured interviews and a purposeful sampling to select the three categories of people who are associated with the quality of home care,namely,home care managers,nurses,and clients.A total of 18 people conducted semi-structured interviews.Content analysis of the data was conducted to understand different people who are involved in maintaining the current quality of home care services.Moreover,their needs,expectations,and prospects were also studied.Precipitation of the indicators to verify the field of research results,and to add a level of indicators 1,2 indicators of secondary,tertiary indicators 27.3.The indicator system was furthered demonstrated from the actual to expected level.Furthermore,the meeting method with the experts was adapted,and a total of 10 experts from Shanghai community care quality management,general hospital nursing quality management,and other fields,were invited.The target number of participants was as expected,and the meeting on the appropriate index extraction and comprehensive indicators lasted 3 hours 50 minutes.Furthermore,a framework for the quality index system of home care service was ultimately developed.Part ?: The establishment of an evaluation indicator system and the weight value of professional home care quality.This part used the evaluation index system model for professional home care quality through Delphi expert consultation,and the weight and assignment of each index were obtained through analytic hierarchy process(AHP).Finally,the score of each index was established.1.An evaluation index system for professional home nursing service quality was modified and established using the Delphi method.A total of 20 experts in different management levels and work areas,such as community health management,three general hospital management,public health management,and home care,were selected.The two-round Delphi correspondence was performed to further supplement,delete,modify,refine,and filter the index system of the preliminary formation.The qualitative analysis and descriptive statistical method were used to statistically manage the results.Finally,an evaluation index system model of home nursing quality was established.2.The weight and assignment of the quality evaluation indicator system of professional home care service were obtained: The hierarchical analysis method was adapted to establish the target tree graph by establishing the hierarchical structure model,and a comparison matrix was established.The whole weights and weights of each index were calculated,and a consistency test was performed.Finally,based on the Delphi method and AHP,the scores of each index and points of assessment were determined by the experts.The index system was modified into an assessment scale of the nursing home care service quality.Part ?: The empirical study on the evaluation index system of home care service quality.Using the established home nursing quality assessment scale through a cross-sectional survey,the stratified cluster sampling consisted of the three main urban areas and urban and rural areas in Shanghai and 38 community health service centers in the suburbs.Through on-site assessment and comprehensive evaluation,data on the quality of whole home care service in Shanghai was obtained.Results Part ?: Framework formation of the evaluation index system of professional home nursing service quality.The field study confirmed 2 level indicators,namely,structural quality indicators and process quality indicators,and 10 secondary-level indexes were related to the system of home care,ambulance equipment,emergency plan,examination,assessment,family nursing before operation of disinfection and isolation,nursing operation,home health education and guidance home care,and disposal.In addition a total of 38 tertiary-level indicators were identified.Based on a semi-structured interview supplementing one first-level indicator,the quality indicators,5 indicators in level two,respectively was the home care staffing,rehabilitation nursing,basic nursing,nursing staff and patients outcome and node 27 level three entries.Through a meeting with experts that further improved the indicator system,the index connotation,calculation formula,and the index were determined.The main evaluation of each index points and requirements was also provided.The final formation of the index framework included three primary-level,16 secondary-level,and 73 tertiary-level indicators along with the main points of the evaluation and requirements.Part?: The establishment of the evaluation indicator system and the weight value of the professional home nursing quality.1.The Delphi consultation results showed that the expert consultation response rate was 100% for two rounds.Moreover,the first round of coordination results showed that the primary-level indicators have an authoritative index of 0.086,secondary-level indicators 0.168,and tertiary-level indicators 0.221.The second round of coordination results showed that the authoritative index was 0.570,the secondary index was 0.363,the tertiary index was 0.489(P <0.05),and the expert authoritative coefficient was 0.82.Two level index revision of 2,delete 1 items,three indicators to remove 6,revised 18,Merge 2,increased 1.Finally,the evaluation index system that included three primary-level 15 secondary-level indicators,and 59 tertiary-level indicators,and three evaluation indices of the key points and requirements were established.2.The weight of the combination and various indices were obtained through AHP.The weight coefficient of the first-grade index was 0.312,the process quality was about 0.490,and the quality of the outcome was 0.198,respectively,from a combination of weight distribution,in the top two were: family caregivers' guidance,the weight coefficient was 0.050,the family nurse nursing operation the process specification,the weight coefficient was 0.045.Part ?: The empirical study on the evaluation index system of home care service quality.1.Cronbach'S a coefficients 0.879 of the process quality module,the a coefficient of the structure quality module 0.802,and the a coefficient of outcome 0.701 is the lowest.The content of questionnaire for home care quality was recognized by answers during nvestigation.The correlation coefficient 0.968(P < 0.001),and the internal consistency coefficient 0.826.2.The overall score of home care quality was the average score of home nursing service quality in Shanghai was 72.74 points.Excellent and good ratings have a percentage of 39.5%,and the below standard rate was 23.7%.The overall urban area,urban and rural integration,suburban total scores are presented(F = 3.938,P = 0.029,P <0.05).The urban and rural areas had a total of 80.61 points,followed by 73.33 in the main urban area and 61.93 in the suburbs.3.Based on the results of different modules of the 38 community health service centers in Shanghai,the structure of the quality module had an average score of 71.2 points,the quality of the process module had an average score of 86.6 points,and the quality of the outcome module had an average score of only 44.1 points.Conclusion1.In this study,the indicator system of home care quality evaluation was closely integrated to three aspects,namely,structural quality,process quality,and outcome quality.It can be used by health administrative department and community care provider to evaluate and improve the home care quality.A good application value was observed based in empirical research.2.The evaluation results of home nursing quality in Shanghai showed that the services of the community health service center should be improved in terms of meeting home care needs.Moreover,quality control should be further strengthened and improved,particularly in underdeveloped areas. |
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