Research On The Construction Of The Evaluation Index System Of The Elderly’s Sense Of Medical Gain

ObjectiveThe study constructs an evaluation index system based on the actual medical demand characteristics of the elderly population and the theory of "sense of gain".It provides evaluation and measurement tools for assessing elderly’s sense of medical gain,and conducts empirical research to test the feasibility of the index system by using Guangzhou and Huizhou as examples.It examines elderly people’s sense of gain toward the variety of medical services provided by hospitals in Guangdong Province,analyzes demographic and sociological factors affecting their sense of gain,and makes relevant recommendations,to serve as a reference for promoting the provision of high-quality medical services to the elderly and the establishment of a medical friendly system for them.MethodsThe first stage of the study was to develop an evaluation index system that used evidence-based evaluation methods to measure elderly people’s sense of medical gain.This stage involved developing a unified search strategy,searching relevant databases and online resources,collecting information about medical accessibility,the quality of services for elderly patients,as well as understanding the current research status,evaluating the literature according to the principles and steps of evidence-based evaluation methods,and grading its quality according to the standard for grading evidence.In this stage,evidence levels were classified into five categories: A,B,C,D,and E,with Level A referring to systematic review and meta-analysis;Level B referring to government and related agency reports;Level C referring to quantitative research literature;Level D referring to qualitative research literature;and Level E referring to literature reviews.Indicators are selected based on the quality of evidence found in the literature and the overall citation frequency of the indicators.Then combined with the theories of the sense of gain and the actual needs of the elderly,a basic framework and dimensions for an evaluation indicator system were constructed.By the end of this stage,a preliminary evaluation indicator system was developed for evaluating the elderly’s sense of medical gain.In the second stage of research,an evaluation index system was revised and determined using Delphi expert consultation and the Analytic Hierarchy Process.On the preliminary evaluation indicator system,three rounds of Delphi expert consultation were conducted,and based on the results of the first and second rounds of expert scoring and specific suggestions,indicator items were added,modified,or deleted,and the indicator structure was adjusted and improved.A third round of expert consultation used an Analytic Hierarchy Process to calculate the weight of each indicator based on the pairwise comparison matrix of each expert.To calculate the weight value of each indicator,Matlab R2022 b software was used to verify the consistency of the results filled in by each expert.In the end,the final weight value was calculated as the average of the weights given by all experts who passed the consistency test.As a third step,an empirical study was conducted in order to construct an indicator system for elderly people’s sense of medical gain.The on-site survey was conducted on two streets in Guangzhou and two streets in Huizhou,Guangdong Province.A total of 593 questionnaires were collected,of which 565 were valid and had an effective rate of 95.28%.The questionnaire was analyzed through descriptive analysis,reliability and validity tests,Mann Whitney tests,and Kruskal Wallis rank sum tests by SPSS26.0 and Amos24.0software to verify the feasibility of the indicator system.And an analysis of current situation of elderly people’s sense of medical gain in Guangdong Province,as well as the factors influencing their sense of medical gain,is provided.ResultsThe first step was to develop an evaluation index of elderly people’s sense of medical gain.A total of 94 articles were identified through evidence-based evaluation.There were 0articles at level A,4 articles at level B,75 articles at level C,10 articles at level D,and 5articles at level E.An initial evaluation index system for the sense of medical gain of elderly people was constructed by combining the overall citation efficiency of the indicators with the level of evidence in the literature,as well as relevant policies and theories of "sense of gain".Finally,this index system was classified into two levels,with 4indicators in the primary and 22 indicators in the secondary.The second stage was to revise the evaluation index system for elderly people’s sense of medical gain.This study found that the three rounds of Delphi expert consultation had positive coefficients of 100%,95.83%,and 65.22 %,respectively.The first and second rounds of experts showed high enthusiasm(>70%),and the authority coefficients of the three rounds of experts were 0.94,0.93,and 0.88,all meeting the inclusion criteria(>0.7).The Kendall harmony coefficients of the first and second rounds were between 0 and 1,and the test results showed that the expert scores were consistent(P<0.05).Then consistency testing was analyzed on the scoring results of the third round of experts,and obtain the scoring values of the judgment matrix of 9 experts after passing the test.The expert consultation results are reliable.Through three rounds of Delphi expert consultation,the indicator items and system were adjusted and improved.At this stage,four indicators were identified in the primary level and 23 indicators were identified in the secondary level.Additionally,The CR value of the primary indicators judgment matrix is obtained between0.043 and 0.096,and the CR value of the secondary indicators is between 0.003 and 0.097.The weight values of four primary indicators,the sense of gain in medical environment,the sense of gain in medical services,the sense of gain in medical engagement and the sense of gain in medically emotional experience for the elderly were 0.159,0.389,0.248,and 0.204,respectively.The third stage is an empirical evaluation index system for elderly people’s sense of medical gain.An on-site survey was conducted in four streets of Guangzhou and Huizhou in Guangdong Province.After statistical analysis of the survey results,it was found that the overall reliability and validity of the evaluation index system for the elder’s sense of medical gain were acceptable.The overall Cronbach α coefficient of the index system was0.951,with a half reliability of 0.861,indicating positive on reliability.In exploratory factor analysis,the KMO value of this study was 0.951,which meets the prerequisite for exploratory factors.Principal component analysis was used to extract four common factors,with a cumulative contribution rate of 71.673%.The factor load of 23 questionnaire items met the acceptance criteria,and the factor load of 22 questionnaire items was greater than0.5,which is consistent with the theoretical concept of the index system;In confirmatory factor analysis,the fitting indicators all met the standards,the mean variance extraction value(AVE)was greater than 0.5,and the combined reliability(CR)was greater than 0.8.The degree of model fitting was acceptable,and the overall structural validity was good.Furthermore,descriptive analysis was conducted on the survey data without weighted score of 3.61(2.96～4.13)among all the valid questionnaires.In terms of primary level indicators,the dimension of "the sense of gain in medical environment" scored the highest.In terms of secondary indicators,"the diagnosis and treatment costs incurred during medical treatment are acceptable" scored the lowest.It was found that gender,marital status,and type of disease are demographic and sociological factors that influence elderly people’s sense of medical gain.ConclusionAs a result of this research,an evaluation index system for elderly people’s sense of medical gain has been constructed,which is systematic,scientific,and practical,which can provide a reference for scientific measurement and evaluation of elderly people’s sense of medical gain.Through empirical research,it is found that the elderly have a high level of sense of gain in the medical environment,and the level of sense of gain in medical participation,emotional experience,and medical services needs to be further improved.A series of suggestions is proposed to improve the elderly-friendly medical environment,optimize the medical process,clarify priority service standards,improve service quality and provide health education for the elderly.Nevertheless,this study recommends that social demographic differences should be taken into account during the application stage in order to make sure the results are scientific.