Research On The Comprehensive Evaluation Index System Of Medical Quality In Provincial Psychiatric Hospitals

Medical quality management is an important area of hospital management.Assessment,measurement and improvement of medical quality has always been a focus in the field of hospital management research.Most existing studies of medical quality focused on general hospitals,with limited data about psychiatric hospitals.In recent years,while the demand for mental health services in China has increased,the medical quality in psychiatric hospitals is experiencing some decline.Therefore,monitoring and improving medical quality is of importance to improve the management of psychiatric hospitals,especially for provincial psychiatric hospitals.The medical quality evaluation index system of general hospitals is often not applicable to psychiatric hospitals.Therefore,it is necessary to develop the medical quality evaluation system specially for psychiatric hospitals.On the other hand,although some studies have been done focusing on the evaluation system of the medical quality of the macro mental health service system in the community in general,few studies have been done to evaluate the system of the medical quality of psychiatric hospitals.The aim of this study was to explore the evaluation system of medical quality for provincial psychiatric hospitals in China,with potential significance in theory as well as in practice.There were three components in this study.The first component was to use the modified Delphi method and analytic hierarchy process to build a model of medical quality evaluation system for provincial psychiatric hospitals in China.We first performed a systematic review of current literature and the research progress,and developed a pool of potential indicators of medical quality measurement for psychiatric hospitals.Twenty experts from relevant specialties were invited for expert consultations.Then an expert evaluation model was constructed.In this model,there were 3 first-level indicators,10 second-level indicators and 34 third-level indicators.Among them,the weight of result quality index was 0.614,the weight of process quality index was 0.211,and the weight of structure quality index was 0.175.Among the quality of outcomes,the most important indicator was the efficacy index,followed by the overall satisfaction of discharged patients.The second component was the application of expert evaluation model.The measurement indexes in the expert evaluation model were transformed into three sets of questionnaires,which were the institutional questionnaires for investigating the basic information of hospitals,the patient questionnaires for investigating the clinical information related to the medical records of discharged patients(doctor part),the patient questionnaires for investigating the satisfaction of discharged patients(patient part).The reliability and validity of questionnaires were tested.This study relied on the third-party evaluation project to further improve the effectiveness of the national medical service action plan,carried out a special evaluation of the medical quality of provincial psychiatric hospitals,collected the relevant data from 32 provincial psychiatric hospitals,and evaluated them with the expert evaluation model.The results showed that the evaluation results of the expert evaluation model were consistent with the ranking in the minds of peers,and the reliability and validity of the expert evaluation model were acceptable.In the third component,based on the classical medical quality theory of "structure-process-result",the initial model and saturation model were constructed by using the partial least squares structural equation modeling(PLS-SEM),starting from the expert evaluation model.Based on the empirical data of 32 psychiatric hospitals,the saturation model was selected as the basis of the study.Fifteen measurement indicators with insignificant weights were excluded and the modified model was optimized.In the revised model,there are three first-level indicators,8 second-level indicators and 14 third-level indicators.The weights of each measurement index had a certain degree of change compared with the weights of the measurement index in the expert evaluation model.Based on the findings,the relationship between structure,process and result was discussed.The results showed that the structure had a significant positive effect on the process,the process had a significant positive effect on the results,and the structure had a significant positive effect on the results.