安宁疗护服务综合评价指标体系构建研究  

Development of a Comprehensive Assessment System of Hospice Care

作　　者：许艺帆 荆丽梅 王丽丽 王昭林 李宇涵 陆雯源 张琴华 王浩燃 景笳恒 李水静 XU Yifan;JING Limei;WANG Lili;WANG Zhaolin;LI Yuhan;LU Wenyuan;ZHANG Qinhua;WANG Haoran;JING Jiaheng;LI Shuijing(School of Public Health,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Primary Health,Shanghai Municipal Health Commission,Shanghai 200125,China)

机构地区：[1]上海中医药大学公共健康学院,上海市201203 [2]上海市卫生健康委员会基层卫生健康处,200125

出　　处：《中国全科医学》2023年第22期2793-2799,共7页Chinese General Practice

基　　金：上海市科学技术委员会软科学研究项目(23692112700);教育部人文社会科学研究规划基金(20YJAZH045);上海市科学技术委员会自然科学基金项目(22ZR1461400)。

摘　　要：背景 在全国推进安宁疗护试点初期阶段,亟须综合评价试点机构的安宁疗护服务质量和效果。目的 探索构建一套适用于中观机构层面的安宁疗护服务综合评价指标体系,以期为各试点机构的安宁疗护服务评价和比较提供科学工具。方法 于2021年4—5月,通过文献评阅和小范围专家访谈初步构建安宁疗护服务综合评价指标池;于2021年6—7月,采用兰德(RAND)/加州大学洛杉矶分校(UCLA)德尔菲法开展两轮专家咨询,从相关性、可测量性、可行性3个维度对指标进行1~9级评价。结果 经过两轮专家咨询对指标体系进行修正完善,最终构建的指标体系包含3个一级指标(结构、过程、结果)、9个二级指标(政策保障、服务提供、患者负担等)、25个三级指标(机构制度保障、服务数量、次均费用等)和81个四级指标(纳入机构发展规划、出院人数及人均医药费用等)。第一轮专家咨询的专家积极系数为93.3%,权威系数为0.900,3个一级指标的肯德尔(Kendall’s W)系数分别为0.194、0.115、0.126;第二轮专家咨询的专家积极系数为92.9%,权威系数为0.900,3个一级指标的Kendall’s W系数分别为0.417、0.241、0.322。结论 基于“结构-过程-结果”框架构建的包含四级指标的安宁疗护服务综合评价指标体系,具有一定的创新性和实践性,能够作为量化评价和比较不同试点机构、不同区域间安宁疗护服务质量和效果的科学工具,有助于促进试点地区安宁疗护服务规范化、同质化发展。Background In the initial promotion of pilot hospice care services(HCS)in China,there is an urgent need to evaluate the quality and effectiveness of HCS comprehensively in pilot institutions.Objective The purpose of this study was to establish a meso-level comprehensive assessment system of hospice care,and to provide a scientific measurement tool for assessing and comparing hospice care in various pilot institutions.Methods An item pool for establishing a comprehensive assessment system for HCS was constructed through a literature review and small-scale expert interviews from April to May 2021,then the items were rated using a 9-1 grading scheme(the highest grade is 9,while 1 is the lowest)in terms of three aspects(relevance,measurability and feasibility)during two rounds of expert consultation conducted using the RAND/UCLA modified Delphi panel method from June to July 2021.Results The Comprehensive Assessment System of Hospice Care(CASHC)was established finally after the items were revised and improved according to the results of two rounds of expert consultation,which consists of 3 primary indicators(structure,process and outcome),9 secondary indicators(policy guarantee,service provision,patient burden,etc.),25 tertiary indicators(institutional system guarantee,number of services,per capita cost,etc.)and 81 quaternary indicators(inclusion of institutional development plan,number of hospital discharges and per capita medical cost,etc.).The first round of consultation achieved a response rate of 93.3%,an authority coefficient of 0.900,with values of Kendall's W for the quaternary indicators calculated as 0.194,0.115,and 0.126,respectively.The second round of consultation achieved a response rate of 92.9%and an authority coefficient of 0.900,with values of Kendall's W for the quaternary indicators of 0.417,0.241,and 0.322,respectively.Conclusion The CASHC consisting of four-level indicators established using the Donabedian's structure-process-outcome framework is an innovative and practical tool,which can be use

关 键 词：临终关怀和姑息治疗护理 卫生保健质量 获取和评价 指标体系 德尔菲法 

分 类 号：R473.51[医药卫生—护理学]