Construction Of Comprehensive Evaluation Index System For Chronic Heart Failure Health Management From The Perspective Of Health Ecology

Objectives Based on literature evidence-based method,the existing evidence of chronic heart failure health management evaluation indicators was reviewed and screened,and the best evaluation indicators and evaluation tools were extracted and integrated.Based on the results of evidence synthesis and supported by the theory of health ecology,a comprehensive evaluation system of chronic heart failure health management was constructed in accordance with China’s national conditions.Methods1.Literature evidence-based: evidence synthesis of chronic heart failure health management comprehensive evaluation index system constructionBased on the evidence-based method,the research on health management of chronic heart failure was systematically searched from the national Guideline database of the National Guideline Clearinghouse,Medlive,Med Scil,Web of Science,EBSCO,CNKY,Wan Fang,Chinese Biomedical and other domestic and foreign guideline networks and databases,and the relevant literatures on health management of chronic heart failure were screened according to the criteria of natting.The quality evaluation was conducted,the highest level of evidence was summarized,and the results of classification were divided according to the recommendation level.The evaluation indicators and evaluation tools selected in the health management of chronic heart failure were summarized based on the health ecology theory,providing research strategies,basic framework and specific contents for the construction of the comprehensive evaluation indicator system of chronic heart failure health management.2.System construction: Delphi method was used to construct the comprehensive evaluation index system of chronic heart failure health management from the perspective of health ecologyOn the basis of comprehensive evidence,the framework of comprehensive evaluation index system for chronic heart failure health management from the perspective of health ecology was preliminarily developed,the draft of expert correspondence questionnaire was prepared,and the Delphi method was used to conduct two rounds of expert correspondence consultation,and the results were analyzed.Combined with the coefficient of variation,average score and expert opinion,the index contents of the evaluation index system were screened and determined to form the final comprehensive evaluation index system of chronic heart failure health management from the perspective of health ecology.Results1.After literature retrieval and screening,a total of 22 studies were included,including 9 clinical guidelines,3 systematic reviews,8 randomized controlled trials and 2 quasi-experimental studies.A total of 35 pieces of evidence related to chronic heart failure health management evaluation indicators were collected,including 17 pieces of recommendation level A and 18 pieces of recommendation level B,which were summarized into four levels of individual patients,social support,medical and health services,and health economics on the basis of health ecology theory.2.The research team was set up to improve the preliminary evidence synthesis content according to the existing knowledge level and practical experience,forming the draft of chronic heart failure health management comprehensive evaluation index system.Thirty experts engaged in cardiovascular clinical medicine,clinical nursing,chronic disease management,nursing management,health administration and other fields were selected for two rounds of letter consultation.The final effective recovery rate of the two rounds of questionnaire was 100%,the expert authority degree was 0.873 and 0.882,and the Kendall’s W was 0.252 and 0.275,respectively.The results were statistically significant(P<0.05).3.The comprehensive evaluation index system of chronic heart failure health management from the perspective of health ecology was finally formed,including 4first-level indicators,namely individual patients,social support,medical and health services,and health economics;14 secondary indicators,including symptoms and signs,cardiac function,test indicators,psychological state,health behavior,other related indicators,perceived(subjective)social support,actual(objective)social support,support availability,health management team,information platform,management quality,disposable cost,actual expenditure cost;And 43 tertiary indicators.ConclusionsThis study used literature review,evidence-based nursing,and Delphi method,based on ecology theory,health from the individual patients,social support,medical and health services,health economics,four aspects to construct the comprehensive evaluation index system of health management of chronic heart failure.It provides the basis for the standardized development of health management and improves the comprehensive evaluation ability of health management of chronic heart failure of medical staff,so as to further optimize the health management model of chronic heart failure.