The Establishment And Empirical Study On The Quality Indicator System Of Postoperative Pain Management

Objective:To establish a quality indicator system of postoperative pain management and test its reliability,validity and discrimination.Methods:? Our study was based on the“Structure-Process-Outcome" model.A comprehensive literature search strategy was established to determine the original quality indicators of postoperative pain management,and preliminary quality indicators were determined through the group discussion method.The Delphi method was applied to defined the finial quality indicators by consulting 15 experts in postoperative pain management.The analytic hierarchy process(AHP)method was used to determine the weight of each indicator? We designed department questionnaire,patient medical records questionnaire,and patient outcome questionnaire to reflect the quality of structure,process and outcome respectively.We also designed the synthetical scored method of postoperative pain management through the group discussion,which consisted of rating level,evaluation method,total score calculation method of each indicator.We selected nine orthopaedic departments of nine hospitals by purpose and convenience sampling methods to carry out the empirical research.First,testing the reliability and validity of the questionnaires designed.Second,analysing the correlation of the rank of nine departments,calculated by the synthetical scored method of postoperative pain management established in this study and the two traditional methods of weighted TOPSIS method and the weighted rank-sum ratio method.Third,the nine departments were divided into two groups:painless wards and non-painless wards.Two independent samples t-test was used to analyze the differences between the two groups in order to verify the discrimination of the quality indicator system.Finally,a designed questionnaire was used to investigate 12 surveyors' application perceptions of using the quality indicator system.Results:? A quality indicator system,including three first-level,eight second-level and 32 third-level quality indicators,was established.The weight of first-level quality indicators of structure,process,outcome was 0.2,0.4 and 0.4 respectively;the first three quality indicators with high combined weights in the second-level were analgesic effect(0.27),pain assessment and reassessment(0.16),pain treatment(0.16);the first three quality indicators with high combined weights in the third-level were the rate of moderate to severe pain on ambulation(0.14),the rate of moderate to severe pain at rest(0.08),the rate of health education adequacy(0.07).? A total of two common factors were extracted from patient outcome questionnaire,the cumulative variance contribution rate was 80.38%,and Cronbach's a coefficient of the total questionnaire was 0.95;the I-CVI of department questionnaire,patient medical records questionnaire,and patient outcome questionnaire were all in 0.875-1.000,and the S-CVI was 0.98,0.97 and 0.98 respectively.The synthetical scored method,including rating level,evaluation method,total score calculation method of indicators was established.Each indicator was divided into five levels and accompanied by a rating instruction,each level was assigned to 1,0.75,0.5,0.25,0 points according to the situation of department surveyed.The results of the synthetical scored method were positively correlated with the weighted TOPSIS method and the weighted rank sum ratio method,correlation coefficients were 0.933(P<0.000)and 0.833(P<0.005).The score of structure,process,and outcome quality indicators and total score of the painless wards of orthopedics department were all better than those in the non-painless wards,the difference was statistically significant(P<0.05).The above results showed that the quality indicator system established in this study had good reliability,validity and discrimination.Conclusions:The quality indicator system of postoperative pain management established in this study consisted of three first-level,eight second-level and 32 third-level quality indicators,which was comprehensive and scientific.It had good reliability,validity and discrimination,and can reflect the multidisciplinary cooperation and process characteristics of postoperative pain management,and effectively distinguish the quality of postoperative pain management of different departments.