服务差距模型的医养结合型养老机构安宁疗护质量评价体系的构建 [中文引用][英文引用]

目的  基于服务差距模型（service quality）构建医养结合型养老机构安宁疗护质量评价体系，为该类机构护理人员开展安宁疗护服务质量评价及改进提供参考。方法  以 SERVQUAL 模型为理论框架，通过文献回顾和半结构访谈结果初步形成评价体系框架，采用德尔菲专家函询进行 2 轮专家函询，对指标进行筛选和修改，最终确定评价指标体系。结果  2 轮专家咨询均发放和回收问卷 15 份，有效回收率均为 100.00%，说明专家积极性高；专家权威程度分别为 0.78。2 轮函询一级指标的 Kendall 协调系数 W 分别为：0.198 和 0.235（均 P<0.05），且第 2 轮 W 值优于第 1 轮。第 2 轮各指标重要性评分为 3.93~5.00分，变异系数 0~0.20，权重 0.01~0.28。最终构建的医养结合型养老机构安宁疗护质量评价体系包括 5 项一级指标、17 项二级指标和 64 项三级指标。结论  基于 SERVQUAL 模型构建的医养结合型养老机构安宁疗护质量评价体系具有科学性和可靠性，可为医养结合型养老机构开展安宁疗护服务质量评价提供参考，促进护理质量同质化，满足老年人及其家属的需求。

Objective To develop and evaluate a quality assessment system for palliative care nursing homes that integrate medical and elderly care services based on the SERVQUAL model，thereby providing references for assessment and improvement of the quality of palliative care. Methods Using SERVQUAL model，a preliminary evaluation of a quality assessment system for palliative care was developed through literature review and semi-structured interviews. Two rounds of expert consultation with Delphi method were conducted to refine and finalise the assessment system. Results The two rounds of expert consultation each involved 15 questionnaires， all effectively returned（100.00% response rate），reflecting strong expert engagement. The expert authority coefficients were 0.78. The Kendall’s W of primary irdicators were 0.198 in the first round to 0.235 in the second（P<0.05），showing improved consensus. The mean importance scores in the second consensus were 3.93-5.00，with coefficients of variation of 0-0.20，and weights of 0.01-0.28， respectively. The finallised assessment system comprised 5 primary indicators，17 secondary indicators and 64 tertiary indicators. Conclusion The SERVQUAL-based palliative care quality assessment system for integrated medical-elderly care nursing homes is scientifically rigorous and practically applicable. It offers a standardised tool for assessment and improvement of the quality of palliative care in nursing homes with integrated medical and elderly care services，promotes homogenisation of nursing quality and ultimately meets the needs of residents and their families.