国内基于结构-过程-结果模型的老年人长期照护服务质量评价指标体系研究的系统综述

A systematic review of studies in China on the evaluation index system of quality long-term care service for elderly based on structure-process-outcome model

目的对国内基于结构-过程-结果(structure-process-outcome,SPO)理论模型构建的老年人长期照护服务质量评价指标体系进行系统综述,了解其基本特征及其不足之处,为构建更合理的长期照护质量评价指标提供参考。方法检索6个中文数据库,时限为建库至2020年2月,通过EndNoteX9进行文献剔重,制定纳入标准与排除标准筛选文献,采用Excel表格提取文献资料,使用定性描述分析方法对指标体系构建的基本信息、指标内容进行归纳分析。结果共纳入9篇文献,包括9个指标体系,二级指标27个,三级指标165个。其中9个指标体系采纳频次前20%的二级指标19个,三级指标45个。8篇研究质量指标筛选方法采用德尔菲法,3篇研究质量指标赋权方法采用层次分析法。结论国内基于SPO模型的老年人长期照护服务质量评价体系构建,其结构维度注重软硬件综合考察,过程维度体现老年人长期照护“医”与“养”结合,结果维度强调主客观综合评价的特征。但指标选取和赋权方法相对单一,体现老年人功能维护的相关指标不足,指标体系对不同功能状态服务对象及其服务需求的特异性有待提升。

Objective To systematically review the researches carried out in China with the quality evaluation index system based on the structure-process-outcome(SPO)model for elderly long-term care,so as to understand its basic characteristics SPO and its shortcomings,and to provide a reference for the development of a more reasonable quality evaluation system.Methods Six Chinese databases from the inception to February 2020 were searched.After deletion of the duplicate papers with the EndNoteX9,the included literatures were screened following the inclusion criteria and exclusion criteria.Literature data were extracted using Excel.The qualitative descriptive analysis method was used to analyse the basic information and indicators of the systems.Results A total of 9 literatures,9 index systems,27 secondary indexes and 165 tertiary indexes,were included.Nineteen secondary indicators and 45 tertiary indicators were adopted in the top 20%of the 9 index systems.Delphi method was used to filter the quality indicators of 8 studies,and analytic hierarchy process was used to weight the quality indicators of 3 studies.Conclusions The quality evaluation of long-term care service quality for the elderly based on SPO model in China has following characteristics:its structure focuses on the comprehensive investigation with both of software and hardware,its process reflects the combination of medical and nursing,and its outcome emphasises the comprehensive subjective and objective evaluation.However,the method of index selection and empowerment is relatively simple,and the relevant indicators that reflect the functional maintenance of the elderly are insufficient.The specificity of the index system for service objects in various functional states and their needs shall to be further improved.