Journal of nursing management · 2026
Development of a Quality Assessment Index System for Palliative Care Services in Chinese Nursing Homes: A Modified Delphi and Analytic Hierarchy Process Study.
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Zhang Lu, Wu Xiao-Qin, Tan Ling, Wen Ping-Pin, Sun Zhi-Xiang, Yang Mei-Fang, Huang Yue-Lin, Fu Jing
Аннотация
BACKGROUND: As the population ages, nursing homes are key end-of-life care settings, making high-quality palliative care essential for safeguarding older adults' quality of life. However, China currently lacks a unified and systematic tool for evaluating the quality of palliative care services in nursing homes.
AIM: To develop a quality assessment index system for palliative care services tailored to Chinese nursing homes.
METHODS: The study employed a mixed-methods design with three phases: (1) a literature review (40 studies, 36 policy/guideline documents; 2013-2023) and semistructured interviews with stakeholders from 6 nursing homes; (2) three rounds of modified Delphi expert consultation (n = 31, 27, 23) to revise and refine the indicators; and (3) application of the analytic hierarchy process (AHP) to determine indicator weights.
RESULTS: The final index system comprises 3 first-level, 22 second-level, and 47 third-level indicators. The expert authority coefficient (Cr) exceeded 0.85 across all consultation rounds. Expert consensus increased with each round (Kendall's W: 0.189 to 0.315, p < 0.05). AHP results indicated that among the first-level indicators, "process" had the highest weight (0.4114), followed by "structure" (0.3208) and "outcome" (0.2678). Within these dimensions, the highest weighted second-level indicators were "human resources planning and management" (0.0836), "comfort care services" (0.0861), and "quality of symptom management" (0.0438). Furthermore, key third-level indicators included "financial support and management" (0.0632), "basic nursing services" (0.0465), and "quality of symptom assessment and management" (0.0438).
CONCLUSION: This study developed a scientifically grounded quality assessment index system for palliative care services in Chinese nursing homes, which offers a preliminary framework for institutional self-evaluation and quality improvement efforts pending further empirical validation.
IMPLICATIONS FOR NURSING MANAGEMENT: Once empirically validated, the framework may assist managers and staff in nursing homes to identify service gaps, optimize resource allocation, and support a shift toward an "older adult-centered" holistic care model.
AIM: To develop a quality assessment index system for palliative care services tailored to Chinese nursing homes.
METHODS: The study employed a mixed-methods design with three phases: (1) a literature review (40 studies, 36 policy/guideline documents; 2013-2023) and semistructured interviews with stakeholders from 6 nursing homes; (2) three rounds of modified Delphi expert consultation (n = 31, 27, 23) to revise and refine the indicators; and (3) application of the analytic hierarchy process (AHP) to determine indicator weights.
RESULTS: The final index system comprises 3 first-level, 22 second-level, and 47 third-level indicators. The expert authority coefficient (Cr) exceeded 0.85 across all consultation rounds. Expert consensus increased with each round (Kendall's W: 0.189 to 0.315, p < 0.05). AHP results indicated that among the first-level indicators, "process" had the highest weight (0.4114), followed by "structure" (0.3208) and "outcome" (0.2678). Within these dimensions, the highest weighted second-level indicators were "human resources planning and management" (0.0836), "comfort care services" (0.0861), and "quality of symptom management" (0.0438). Furthermore, key third-level indicators included "financial support and management" (0.0632), "basic nursing services" (0.0465), and "quality of symptom assessment and management" (0.0438).
CONCLUSION: This study developed a scientifically grounded quality assessment index system for palliative care services in Chinese nursing homes, which offers a preliminary framework for institutional self-evaluation and quality improvement efforts pending further empirical validation.
IMPLICATIONS FOR NURSING MANAGEMENT: Once empirically validated, the framework may assist managers and staff in nursing homes to identify service gaps, optimize resource allocation, and support a shift toward an "older adult-centered" holistic care model.