Construction Of Chronic Disease Home-Based Rehabilitation Services Quality Indicators System Based On Contracted Services Of Family Physicians

ObjectivesTo construct a scientific and reliable index system for evaluating the quality of home-based rehabilitation services for chronic diseases and to determine the weight of the index,and to provide a reference for the quality management of home-based rehabilitation for chronic diseases in China.MethodsThe phenomenological research method is adopted to select family physician,physical therapist,doctor,nurse from 3 community hospitals and 2 level-A hospitals in Jinan City of Shandong Province as the interviewes through objective sampling.Semi-structured interviews are conducted on them.According to the structure-process-result three-dimensional quality structure model,the collected interview data were sorted out and analyzed.Integration is the result of qualitative interviews and literature review,to preliminarily formulate first round expert letter questionnaire of chronic disease home-based rehabilitation service quality indicators system based on contracted services of family physicians.After the application of Delphi expert consultation method(Delphi)to two rounds of expert enquiry for 26 experts,to form the final version chronic disease home-based rehabilitation service quality indicators system based on contracted services of family physicians,and through the analytic hierarchy process(AHP)and expert importance assignment average allocation method is applied in determining weights of indicators at all levels.Findings1.This study extracted two themes:the current situation and key indicators of the quality evaluation of the chronic disease home-based rehabilitation services.2.In this study,a total of 26 nursing experts participated in Delphi expert letter consultation.After two rounds of letter consultation,the expert opinions tended to be consistent.The recovery rate of the two rounds of questionnaires was 100%,and the rate of comments was 53.85%and 30.77%,respectively.The expert authority coefficients of the two rounds were 0.870 and 0.883 respectively,indicating that the expert authority was relatively high.The Kendall harmony coefficients of the two rounds were 0.188 and 0.117,respectively,P<0.05,and the differences between the two rounds were statistically significant,indicating that the expert opinions tended to be the same.Finally,chronic diseases home-based rehabilitation services quality indicators system based on contracted services of family physicians is determined to include:3 first-level indicators,20 second-level indicators and 1 11 third-level indicators3.In this study,AHP was used to determine the weights of the first and second level indicators.The weight of the first level index was structure quality(0.2500),process quality(0.5000)and result quality(0.2500).Weight of secondary indicators:personnel allocation(0.3592).organizational framework(0.2715),environment(0.0599),material equipment(0.1185),policy and system(0.1908),health assessment(0.1880),rehabilitation plan(0.1520),home nursing operation(0.0986),rehabilitation guidance(0.1282),follow-up(0.0545),family participation(0.0795),health education(0.1123),management of common chronic diseases(0.0628),Medical information management(0.0795),referral(0.0446),rehabilitation effect evaluation(0.3231),safety evaluation(0.2453),medical resource utilization(0.1085)satisfaction evaluation(0.1615),social and economic benefit evaluation(0.1615).The weight allocation method of expert assignment was used to determine the weight of three-level indicators,and the weight combination of all levels of indicators was determined by probability multiplication.ConclusionsThis study through the literature review of semi-structured interview method and Delphi expert enquiry method to build the chronic disease home-based rehabilitation service quality indicators system based on contracted services of family physicians,including 3 first-level indicators,20 second-level indicators and 111 third-level indicators,using the analytic hierarchy process(AHP)and Delphi expert assignment weight allocation method to determine the weight of each index hierarchy value.The research method is scientific and rigorous,the index content is systematic and comprehensive,and the research results are reasonable and reliable,which can provide a reference for the evaluation and improvement of the quality of chronic diseases home-based rehabilitation services.