Construction And Application Of Quality Evaluation Indicators For Home Care Service Under The Pilot Background Of Chengdu Long-term Care Insurance

Objective This study is aim to evaluate the quality of home care service in the pilot process of long-term care insurance by constructing the evaluation index system of home care service for the disabled.To learn about the current situation and existing problems of home care service in Chengdu,to further improve the quality of life of disabled people and to provide the government with basis on formulation of the quality of home care regulation.Methods This study use literature analysis,interview and on-the-spot investigation,the evaluation points and key links of home care service quality were understood,and the evaluation index system framework was preliminarily constructed.Delphi method were used to select the indexes,and Analytic hierarchy process(AHP)were used to determine the index weights coefficient.The quality of home care was evaluated by questionnaire combine with semi-structured interview through household survey.The basic situation of disabled persons and their home caregiver and their home care quality scores were summarized by descriptive statistics.Rank sum test was used to compare the quality of home care service for disabled persons with different demographic characteristics,disability degree,income level and so on.Results (1)Based on the Structure-Process-Outcome theory model,the evaluation index system framework was constructed from three dimensions: condition quality,process quality and outcome quality.(2)The Delphi method is used to screen the indexes.Finally,a set of evaluation index system is established,which is composed of 3 first-level indexes,12 second-level indexes and 43 third-grade indexes.The results show that the positive coefficient of expert is more than 90%,the authority coefficient is more than 0.70,and the coordination coefficient of expert is statistically significant,which indicates that the result of expert consultation is reliable.(3)The Analytic hierarchy process is used to determine the index weights.The weight coefficients of the three first-order indexes "condition quality,process quality and outcome quality" are 0.1456,0.4936 and 0.3608,respectively.The consistency test showed that both CI and CR were less than 0.1,which indicates that the index weight coefficient is scientific and reasonable.(4)The average score of home care service quality was 84.7 ±6.9 and the percent of average score is higher than 80%,which indicates that the home care service quality of disabled people in the sampling area is acceptable.However,from the average score of each evaluation index,there are still many problems to be improved.(5)The rank sum test showed that there was a significant difference in the quality of home care service in the degree of education and disability(P < 0.05).There was also a significant difference between the home caregiver healthy self-assessment and the daily time of disabled nurses(P < 0.05).Conclusion (1)A set of evaluation tool for quality of home care service was constructed;(2)The weight of evaluation index system is scientific and reasonable;(3)The quality of home caregivers needs to be further improved;(4)Home caregivers are physically and mentally stressed and lack psychological support;(5)Social support for families of disabled persons is insufficient.Suggestion (1)Further improve the quality supervision system for home care services;(2)Strengthen care knowledge and skills training for home caregiver;(3)Broaden the channels of psychological dredging to reduce the psychological load of home caregiver;(4)Build a home-based social support system.