Zhongguo quanke yixue (Aug 2023)

Development of a Comprehensive Assessment System of Hospice Care

  • XU Yifan, JING Limei, WANG Lili, WANG Zhaolin, LI Yuhan, LU Wenyuan, ZHANG Qinhua, WANG Haoran, JING Jiaheng, LI Shuijing

DOI
https://doi.org/10.12114/j.issn.1007-9572.2022.0663
Journal volume & issue
Vol. 26, no. 22
pp. 2793 – 2799

Abstract

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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 used to quantify and compare the quality and effectiveness of HCS among different pilot institutions or different regions, contributing to the promotion of the standardization and homogenization of HCS in pilot regions.

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