医养结合养老机构服务绩效评价指标体系的构建

Construction of a Performance Evaluation System for Elderly Care Institutions Delivering Integrated Medical and Nursing Care

背景当前我国医养结合养老机构绩效评价不够完善,难以保障养老服务的质量,而养老机构绩效评价的结果直接关系到养老服务的质量和养老机构的发展,因此需构建一套医养结合养老机构服务绩效评价指标体系。目的构建一套科学合理的医养结合养老机构服务绩效评价指标体系并对其进行检验。方法2018年8-11月,以电话、面谈等方式对专家进行两轮咨询。接受咨询的专家工作年限均大于10年,从事社会福利行业管理、养老机构管理、老年病管理、卫生行政管理、卫生管理教学、临床医学等研究工作、具有副高级及以上职称。采用层次分析法(AHP)、隶属度分析法等从投入、产出、结果3个维度确定医养结合养老机构服务绩效评价指标体系和权重,采用Cronbach’sα系数对评价指标体系进行信度检验。结果两轮专家权威程度的熟悉程度(Cs)分别为0.679、0.768,选定依据(Ca)分别为0.614、0.657,权威系数(Cr)分别为0.646、0.713。两轮专家咨询的肯德尔协调系数(Kendall’s W)分别为0.394、0.426,两轮咨询的Kendall’s W值比较,差异有统计学意义(χ^2=481.049、504.768,P<0.001)。经过专家咨询、调整、改进,构建了3个一级维度、8个二级维度和49个三级指标组成的医养结合养老机构服务绩效评价指标体系,并对每个指标赋予了相应的权重系数,3个一级维度的权重分别是0.216 3、0.576 2、0.207 5,合成权重CR均<0.10。信度检验结果显示,各个维度的Cronbach’sα系数和总的Cronbach’sα系数均>0.800。结论构建一套医养结合养老机构服务绩效评价指标体系,该指标框架的可靠性和可信性程度较高,为有关部门决策提供科学可行的依据。

Background At present,it is difficult to ensure the quality of services of elderly care institutions delivering integrated medical and nursing care in China,partly due to the imperfect performance evaluation mechanism for such institutions.But correct evaluation results are directly related to the quality of elderly care and the development of such institutions,so it is necessary to construct a sound performance evaluation system for such institutions.Objective To construct and verify a scientific and rational performance evaluation system for elderly care institutions delivering integrated medical and nursing care.Methods From August to November 2018,we conducted two rounds of telephone-based or face-to-face consultations using Delphi technique in experts with 10 years of research experience in social welfare industry management,elderly care institutions management,geriatric disease management,health administration,health management teaching,and clinical medicine and with an associate professor or professor title.We used analytic hierarchy process and analysis of membership function to determine the 3 dimensions(input,outcome and outcomes)and indicator weights of the performance evaluation system for elderly care institutions delivering integrated medical and nursing care.We tested the reliability the system using Cronbach’s alpha coefficient.Results The degree of familiarity(Cs)of the experts’authority in the two rounds of consultation was 0.679 and 0.768,respectively.The selection basis(Ca)was 0.614 and 0.657,respectively,and the authoritative coefficient(Cr)was 0.646 and 0.713,respectively.The Kendall’s W of the two rounds of expert consultation was 0.394 and 0.426,respectively,showing a significant difference(χ~2=481.049,504.768,P<0.001).In accordance with the consultation results,we revised and improved the initial system,and established a performance evaluation system for elderly care institutions delivering integrated medical and nursing care finally,which consists of 3 first-level dimensions,and 8 second-level dimensions,and 49 thirdlevel indicators,and assigned weight to each indicator.The weights for 3 first-level domains were 0.216 3,0.576 2,0.207 5,respectively,and the combined weights CR were all<0.10.The reliability test results showed that the Cronbach’s alpha coefficients of each dimension and the total Cronbach’s alpha coefficients were all>0.800.Conclusion Our system was proved to have high reliability and validity,which can provide scientific and feasible supports for decision-making by related departments.