Identifying quality indicators for home care services: a modified Delphi and Analytic Hierarchy Process study

doi:10.21203/rs.3.rs-3395262/v1

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Research Article

Identifying quality indicators for home care services: a modified Delphi and Analytic Hierarchy Process study

https://doi.org/10.21203/rs.3.rs-3395262/v1

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published 18 Jul, 2024

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Background

As the recipients of home care services, patients have the most direct and profound experience of service quality. There is no knowledge as to quality indicators for home care services from the patients’ perspective. This study aimed to identify quality indicators for home care services based on Service Quality model, and determine the weight of these indicators.

Methods

A two-round online Delphi survey and Analytic Hierarchy Process consultation were conducted to gather opinions from national experts on quality indicators for home care services developed on the basis of the Service Quality model. Consensus was defined as at least 80% agreement on the importance (important and very important) of indicators and among experts. The Analytic Hierarchy Process was used to determine the relative importance of the identified indicators.

Results

The response rate was 95% in the first and 97.4% in the second round. After round two, five first-level and 23 second-level indicators were identified. The Kendall’s W values were 0.54 and 0.40 for the first-level and second-level indicators (p < 0.001). The weight coefficients for the first-level and second-level indicators were 0.110–0.298 and 0.019–0.088, respectively.

Conclusion

The quality indicators for home care services were developed based on the Service Quality model. These indicators will be useful to evaluate and improve the quality of home care services.

home care services

quality indicators

quality of care

Delphi

Analytic Hierarchy Process

nursing management

In response to the growing global aging population and increasing complexity in health problems, many countries tend to move nursing care from hospitals to home care settings [1], including in China. Home care can provide assistance for people with various health care needs to live as independently as possible in their private homes [2]. Evidence have shown that home care can improve patients’ activities of daily living and quality of life [3], and reduce hospital admission [4] and caregiver burden [5]. Home care services vary considerably in scope of service and eligibility requirements between countries, and each country should provide home care services depended on its own guidelines [6].With the rapid development of home care services, there are shared concerns regarding the quality of care.

Due to the increasing burden of aging and relative lack of health service resources, the Chinese Health Committee has proposed developing community and home care services rapidly to satisfy people’s health needs, especially for older adults with chronic diseases [7]. In China, home care is defined as the nursing care and personal care for people of all ages provided by registered nurses in people’s private homes. Home care services are usually provided by registered nurses from community health centers and hospitals, and care recipients are mainly patients who need nursing care after discharge, older adults with chronic diseases and the disabled [8]. Despite the rapidly increasing need of home care, some existing problems may hinder the quality of care, such as shortage of home care nurses, considerable variations in nursing staff competence across home care institutions, and lack of standardised home care rules, regulations, process and quality monitoring system [9]. Home care institutions are under growing pressure to offer good quality of care.

Measurement of service quality plays an important role in ensuring that patients’ needs are satisfied, and identifying areas that required to be improved. Efforts have been undertaken to develop quality indicators for home care, such as the Outcome Assessment Information Set (OASIS) [10], the Home Care Quality Indicators (HCQIs) [11] and the Resident Assessment Instrument-Home Care system (RAI-HC) [12]. These indicators mainly focus on measuring patients’ functional status, basic background information on housing, needs for care, and home care risks. As the recipients of home care services, patients have the most direct and profound feelings and experience of service quality. Measuring quality of care from the patients’ perspective is being increasingly used in healthcare research [13]. Shaller et al. [14] had proposed that the quality improvement in health care should incorporate care recipients’ opinions. Understanding patients’ evaluation of quality of home care services can give clear feedback to service providers to identify problems that need to be improved and facilitate actual improvements in quality of care.

The Service Quality (SERVQUAL) model has been widely used to measure service quality based on consumers’ perspective [15]. It covers five basic dimensions: tangibility (the appearance of the facilities and personnel), reliability (ability to provide the promised service accurately), responsiveness (promptness and helpfulness), assurance (competence, credibility and courtesy) and empathy (caring and individualised attention) [16]. The SERVQUAL model is a concise model to assess service quality within an organization. These dimensions represent the key factors of service provision, however, they may not encompass all factors in all service settings [17]. It has been suggested that researchers should modify the existing indicators or develop their own indicators to their socio-demographic, cultural and geographical context based on the SERVQUAL model [16]. Previous studies have measured service quality on the basis of the SERVQUAL model in public hospital [18], hospice care [19], outpatient teaching hospital pharmacies [20], and dental service [21].

Home environment influenced care or care strategies, and quality of care provided by staff may be hindered by the home environment [22]. Patients are increasingly paying attention to the service quality of home care. There is a need to assess service quality of home care to understand what patients consider as “good care” and to improve the care process and staff functioning. Service quality is highly culture-centric. There is no knowledge as to quality indicators for home care services from the patients’ perspective. Therefore, the objectives of this study were to establish quality indicators in home care services based on the SERVQUAL model, and determine the weight of these indicators. The importance of these indicators lies in evaluating quality of home care services from the patients’ perspective and providing information on areas that need to be improved.

Design

The Delphi technique was applied to reach consensus on quality indicators for home care services. The Delphi method can synthesize the knowledge of a group of experts and has been extensively used for the development of quality indicators in healthcare [23]. We used the modified Delphi technique which consists of beginning the process with a set of carefully selected items [24]. The primary advantages of this modification were to typically improve the response rate, provide a solid foundation based on current evidence, and control the feedback from experts. Analytic Hierarchy Process (AHP) was used to determine the importance of quality indicators for home care services. AHP is a multi-criteria decision-making technique proposed by Satty, and has been used in a variety of clinical decisions because it is methodologically sound and user-friendly [25]. AHP allows to weigh the indicators according to the opinions of a group of experts.

Experts panel

Using a purposive sampling method, we recruited national experts from the fields of home care management, practices, and research. Potential experts were identified from extensive review of the literature or suggested by the members of the research group. The inclusion criteria of experts were as follows: (1) having a minimum of five years of experience in fields related to home care; (2) with a Bachelor’s degree or above; and (3) voluntarily participate in several rounds of consultation. We recruited 40 experts from 6 community health centers, 8 tertiary hospitals and 9 medical schools across 11 provinces (municipalities) in China.

Questionnaire preparation

This study was based on the framework of the SERVQUAL model. A list of potential indicators was drafted by following procedures. First, a literature review of quality indicators for healthcare service based on the SERVQUAL model was carried out to collect a list of indicators. Second, we conducted semi-interviews with home care administrators and home care recipients to further collect indicators. The questions were mainly on the key aspects of service quality for home care services, such as “what home care service is considered good?”, and “which service was good and which was needed to be improved?”. After research group discussion, the initial list of quality indicators included five first-level and 30 second-level indicators: tangibility (6 indicators), reliability (7 indicators), responsiveness (6 indicators), assurance (6 indicators) and empathy (5 indicators). In home care settings, tangibility refers to the equipment, service description and appearance of staff in home care institutions. Reliability refers to the ability of home care nurses to perform the promised service dependably and accurately. Assurance refers to the knowledge and courtesy of home care nurses and their ability to inspire trust among patients. Responsiveness refers to the ability of home care nurses to provide timely service. Empathy refers to caring and individualised attention from home care nurses.

The questionnaire consisted of three sections: (1) preface including research background, objective and methods of the survey, questionnaire completion requirements, time of questionnaire recovery and contact information of the researcher; (2) main text including five first-level and 30 second-level indicators, definition of the indicators, and free-text comments column; and (3) demographic information of experts, such as age, gender, education level, years of experience, areas of expertise and institutions. To check the face validity of the questionnaire, we consulted a home care administrator, a home care nurse and a researcher specialised in home care regarding its wording and clarity.

Data collection

The questionnaires were delivered to experts via e-mail. Experts were instructed to rate the importance of each indicator on a five-point Likert scale (1 = very unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5 = very important). Consensus was defined by at least 80% agreement on the higher level of the five-point Likert scale, namely rating the indicator between 4 and 5 (important and very important). Experts were also invited to make free comments on each indicator and suggest the addition of specific indicators. It took about 20 mins to complete the questionnaire. Each Delphi round was conducted within two weeks, with one month between the two rounds for conducting analysis and indicator refinement. One reminder was sent to experts during the second week of each round if needed. Experts who participated in the first-round survey were included in the second round. In round two, experts were given the results of round one including the mean score, standard deviations (SD) and consensus rating of each indicator. They were asked to re-rate each indicator using the five-point Likert scale and give free comments on indicators.

After the second round, the indicators were finalised, and AHP consultation was then implemented to determine the weight of each indicator. Experts who returned the second-round questionnaires were instructed to weigh each indicator according to their experience and expertise [26]. At each level, pairs for each indicator to other indicators were set in the same level. For each pair of indicators, experts rated the importance of the indicators between one and another using Saaty 1–9 scale (1 = equal, 3 = moderate, 5 = strong, 7 = very strong, 9 = absolute and 2/4/6/8 = intermediate), and the comparison matrix was completed according to the value of relative importance [27]. For example, if the extent of importance of tangibility over reliability was moderate, then the entry of the matrix (tangibility, reliability) was 3, and the entry (reliability, tangibility) was 1/3.

Ethical considerations

The study protocol was approved by the ethics committee of “XXX”. Experts were assured of anonymity and confidentiality. All experts provided the informed consent.

Data analysis

Data analysis was conducted using SPSS 25.0. Categorical data were presented by frequencies and percentages, and continuous data by means and standard deviations (SD) or medians and interquartile range (IQR). Mean and SD for each indicator were calculated to measure the central tendency and dispersion of the ratings, respectively. Kendall coefficient of concordance (Kendall’s W) and chi-square were used to assess the degree of agreement among experts. The Kendall’s W value ranges from 0 to 1. A bigger Kendall’s W value means a higher level of coordination among experts. P < 0.05 was considered statistically significant.

In the AHP, weight coefficients for the first-level and second-level indicators were calculated. The relative importance of indicators was quantified by using Saaty 1–9 scale to construct a pairwise comparison matrix. A higher weight coefficient indicates the indicator is more important. Consistency test was conducted according to the calculated value, with lower consistency ratio (CR) indicating better coordination. CR value < 0.1 was considered acceptable.

Characteristics of experts

Of the 40 experts initially contacted, 38 and 37 experts responded to the first round and second round survey, respectively. The experts represented 23 institutions from the eastern, middle and western regions of China. The median years of experience were 22 years (range 10–34 years) and 21 years (range 10–34 years) for the first and second round, respectively. The characteristics of experts are shown in Table 1.

Table 1

Characteristics of experts
	Round 1 (n = 38)		Round 2 (n = 37)
	N	%	N	%
Age (years)
31–40	13	34.2	13	35.1
41–50	19	50.0	18	48.6
> 50	6	15.8	6	16.3
Gender
Male	1	2.6	1	2.7
Female	37	97.4	36	97.3
Education level
Bachelor	18	47.4	17	45.9
Master	11	28.9	11	29.7
PhD	9	23.7	9	24.4
Years of experience
10–20	18	47.4	18	48.6
21–30	15	39.5	14	37.8
> 31	5	13.1	5	13.6
Areas of expertise
Home care practices	10	26.3	10	27.1
Health care management	16	42.1	15	40.5
Home care research	12	31.6	12	32.4

Round one

95.0% of the experts responded in the first round. Consensus was reached for five first-level indicators: tangibility (86.8%), reliability (92.1%), assurance (94.7%), responsiveness (89.5%) and empathy (86.8%). Based on the consensus, seven (23.3%) second-level indicators were excluded: (1) visually appealing information materials; (2) showing interest in solving the patients’ problems; (3) evident effect of service; (4) willingness to provide services to patients; (5) seeking to help patients; (6) getting enough support from the institution; (7) to be interested in doubts and suggestions of patients. For the remaining 23 second-level indicators, the level of agreement ranged from 81.6–94.7%. Mean scores and SDs for these indicators ranged from 3.68 to 4.74 and from 0.55 to 0.89, respectively. The results of round one are shown in Table S1. Furthermore, adjustments to four (13.3%) second-level indicators were suggested by experts (Table 2). Thus, 23 second-level indicators were included in the second round.

Table 2

Results of quality indicators for home care services in round two
Indicators	Agreement%	Mean ± SD
1Tangibility	89.2	4.48 ± 0.69
1.1 Convenient process to order services	94.6	4.68 ± 0.58
1.2 Detailed description of nursing services	91.9	4.65 ± 0.63
1.3 Transparent charges for nursing services	89.2	4.57 ± 0.69
1.4 Up-to-date equipment	86.5	4.49 ± 0.73
1.5 Nursing staff with dress code and work certificate ^a	86.5	4.32 ± 0.71
2 Reliability	94.6	4.76 ± 0.55
2.1 Performing services right the first time ^a	97.3	4.76 ± 0.49
2.2 Satisfying the needs of patients	91.9	4.51 ± 0.65
2.3 Providing services according to standards	89.2	4.65 ± 0.68
2.4 Providing error-free records for patients	94.6	4.49 ± 0.61
2.5 Providing services with adequate time allocated	94.6	4.54 ± 0.61
3 Responsiveness	91.9	4.59 ± 0.64
3.1 Communicating to patients about service provision	97.3	4.57 ± 0.55
3.2 Telling patients when the service will be provided	94.6	4.73 ± 0.56
3.3 Solving patients’ problems in a timely manner	91.9	4.46 ± 0.65
3.4 Considering patients’ complaints	94.6	4.49 ± 0.61
4 Assurance	97.3	4.73 ± 0.51
4.1 Nursing staff with adequate knowledge and techniques	97.3	4.81 ± 0.46
4.2 Being polite with the patients	91.9	4.78 ± 0.58
4.3 Good communication with patients	94.6	4.73 ± 0.56
4.4 Answering patients' questions carefully	89.2	4.59 ± 0.68
4.5 Feeling safe when using services for patients	89.2	4.70 ± 0.66
5 Empathy	89.2	4.32 ± 0.67
5.1 Respecting and protecting patients’ privacy ^a	89.2	4.70 ± 0.66
5.2 Offering emotional support ^a	83.8	4.49 ± 0.77
5.3 Providing patients with individualized attention	94.6	4.51 ± 0.61
5.4 Understanding the specific needs of the patients	91.9	4.43 ± 0.65

Round two

97.4% of the experts responded in the second round. Consensus was reached on the five first-level and 23 second-level indicators: tangibility (5 indicators), reliability (5 indicators), assurance (5 indicators), responsiveness (4 indicators) and empathy (4 indicators). The level of agreement ranged from 89.2–97.3% for the first-level indicators, and 86.5–97.3% for the second-level indicators. Mean scores for the second-level indicators were higher than those reported in round one and ranged from 4.32 to 4.81, and SDs ranged from 0.46 to 0.77, indicating a more degree of consensus within the expert group. Table 2 presents the results of experts’ ratings of indicators in round two.

Coordination of expert opinions

In round one, the Kendall’s W values were 0.47 and 0.28 for the first-level and second-level indicators, respectively (p < 0.001). In the second round, the Kendall’s W values were 0.54 and 0.40 for the first-level and second-level indicators (p < 0.001), which were more acceptable (Table 3).

Table 3

Coordination degree of expert opinions
	Kendall’s W	χ²	p
Round 1
First-level indicators	0.47	89.25	< 0.001
Second-level indicators	0.28	313.49	< 0.001
Round 2
First-level indicators	0.54	97.30	< 0.001
Second-level indicators	0.40	333.80	< 0.001

Relative importance of indicators

Among the first-level indicators, reliability showed the highest weight (0.298), followed by assurance (0.237), responsiveness (0.182), tangibility (0.173), and empathy showed the smallest value (0.110). CR was 0.021 (CR < 0.1), indicating better coordination. In the second-level indicators, the weight coefficients ranged from 0.019 to 0.088, with CR values from 0.006 to 0.035 (CR < 0.1). Results of the weight coefficients for each indicator are presented in Table 4.

Table 4

Weights of quality indicators for home care services
Indicators		Weight	CR
First-level	1 Reliability	0.298	0.021
	2 Assurance	0.237
	3 Responsiveness	0.182
	4 Tangibility	0.173
	5 Empathy	0.110
Second-level	1.1 Convenient process to order services	0.050	0.006
	1.2 Detailed description of nursing services	0.042
	1.4 Up-to-date equipment	0.033
	1.3 Transparent charges for nursing services	0.031
	1.5 Nursing staff with dress code and work certificate	0.019
	2.1 Performing services right the first time	0.088	0.012
	2.3 Providing services according to standards	0.058
	2.5 Providing services within the promised time	0.055
	2.2 Satisfying the needs of patients	0.051
	2.4 Providing error-free records for patients	0.045
	3.2 Telling patients when the service will be provided	0.050	0.022
	3.3 Solving patients’ problems in a timely manner	0.044
	3.4 Considering patients’ complaints	0.044
	3.1 Communicating to patients about service provision	0.043
	4.1 Nursing staff with adequate knowledge and techniques	0.062	0.004
	4.2 Being polite with the patients	0.056
	4.3 Good communication with patients	0.042
	4.5 Feeling safe when using services for patients	0.040
	4.4 Answering patients' questions carefully	0.038
	5.1 Respecting and protecting patients’ privacy	0.034	0.035
	5.2 Offering emotional support	0.026
	5.3 Providing patients with individualized attention.	0.026
	5.4 Understanding the specific needs of the patients	0.025
CR: consistency ratio

Based on the SERVQUAL model, a suite of 23 indicators assessing five dimensions of service quality in home care settings was developed using the modified Delphi method. These indicators will facilitate improvement in quality of home care services.

In this study, experts from different geographical contexts and the median length of professional experience suggested that the experts represented a broad and experienced group. The response rates in the two rounds of Delphi consultation were more than 95%, indicating that experts showed more concern and continuing enthusiasm with this topic, and considered developing quality indicators for home care services was an important issue. The Kendall’s W value generally ranged from 0.3 to 0.5, reflecting the coordination degree of the expert opinions [28]. In the first round, the coordination degree for the second-level indicators was not ideal (0.28). After modifications according to the expert opinions, the coordination for the second-level indicators was improved (0.40), indicating an increasing level of agreement on all indicators among experts. Moreover, percentages of ratings between 4 and 5 for most indicators were also increased in the second round. Therefore, the final set of indicators can be considered valid and useful to assess quality of home care services.

Indicators of the SERVQUAL model should be modified for different service environments and service subjects. For home care services, reliability dimension included provision of correct services, standardised services, error-free records, adequate time allocation, and satisfying patients’ needs. In terms of importance, reliability showed the highest weight and half of the top 10 indicators in importance belonged to the dimension of reliability. This suggested that experts considered the reliability of home care services to be the most important aspect of quality management. Current challenges for home care services include limited medical resources and equipment, insufficient staff training, and workforce shortages and instability [22, 29], which may be barriers to provide reliable services. Reliability is largely associated with service outcomes [19], and therefore should be monitored and enhanced to ensure the service quality.

Assurance had the second weight, indicating a cognition that assurance is necessary to ensure the quality of home care services. Patients usually perceived home care provided by qualified and experienced staff to be good care [30]. Home care needs of patients are often complex and vary significantly [2], and home care nurses should be qualified to provide quality of care, such as sufficient knowledge and techniques, good communication skills, and patience. Moreover, home care tasks are relatively independent, and carried out with limited cooperation and consultation [31], this also calls for a higher competence for home care nurses. However, most home care agencies lacked systematic training for home care nurses, especially in rural areas [32]. Standardised competency-based training programs should be developed and provided for home care nurses to make them qualified to provide home care services.

For home care recipients, it is important to receive timely care and understand the schedule for their care in advance [33]. Responsiveness dimension showed the third weight and included indicators related to provide timely service and consider patients’ complaints. The pressure of time is a common issue for home care nurses. Increased care complexity, staff shortages and heavy workload contribute to the inability of nurses to ensure timely service [34], and this appears to affect patients’ experience of service and quality of care [22]. Therefore, reasonable arrangement of the service process is needed to provide timely service. Additionally, home care services are usually carried out without close supervision [2]. Complaints from recipients should be resolved effectively.

In this study, tangibility dimension included process to order services, detailed description of care services, up-to-date equipment, charges of services and well-dressed staff, suggesting these indicators should also be targets for quality management for home care services. Medical resources and equipment are critical to quality of home care. A previous study has found that limited medical resources and equipment are problems when providing home care [9]. Allocation of home care resource across geographical areas needs to be addressed to improve the balanced development of home care. Furthermore, order process, descriptions and charges of services should be made easy to acquire for patients to facilitate their good experience of home care services.

Providing home care services in patients’ own homes was described as a loss of privacy, and sufficient empathy was expected from home care nurses [30]. Though it ranked the least importance, empathy should also be emphasised for home care nurses and administrators. According to the identified indicators of the empathy dimension, nurses should give attention to the emotional demands from patients, understand their specific needs and provide care in a respectful way during the process of care delivery. In addition, patients’ privacy should be respected and protected to maintain their autonomy.

The significance of high-quality home care services to patient outcomes is currently under recognising. With the increasing development of home care, the quality of care is also required to be assessed and monitored. It is of great importance to develop indicators to measure the quality of home care services by means of a national consensus. In this way, this study adds to research on development of quality indicators for home care services from the patients’ perspective. Although conducted in a Chinese healthcare context, there is potential for adaption in other healthcare settings. Identification of service quality indicators is helpful to assess and improve the quality of home care services and better meet the needs of home care recipients in the future. Furthermore, these identified indicators will also instruct home care institutions to better provide home care services to patients.

Limitations

There are some limitations in this study. First, this Delphi process was undertaken in a Chinese context. Generalization of the results to countries with different types of home care services should be attempted with caution. Second, instead of selecting experts using random sampling in an expert pool, experts were selected using purposive sampling, which may introduce a selection bias. Third, this was a preliminary study to evaluate the quality for home care services. Future research is needed to confirm the reliability and validity of these indicators.

Five first-level indicators and 23 second-level indicators for quality of home care services have been identified via a national Delphi panel of experts. According to the weight of the first-level indicators, we found that the reliability and assurance dimensions played a leading role in the quality of home care services. This suite of indicators is aimed at being used on home care recipients to help guide home care administrators to monitor and assess the quality of home care services, and find areas to be improved. This can lead to improvement in quality of home care services. Future research is needed to validate these indicators in practice.

Ethics approval and consent to participate

The study protocol was approved by the ethics committee of the First Affiliated Hospital Chongqing Medical University in accordance with the Declaration of Helsinki. All methods were performed in accordance with relevant guidelines and regulations. Experts were assured of anonymity and confidentiality. All experts provided the informed consent.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Competing interests

The authors declared no conflict of interest.

Funding

This study was supported by the Humanities and Social Science Foundation of Chongqing City (No. PY201863).

Authors' contributions

Qiu-Lan Zheng: conception and design of this study, data collection, and manuscript writing; Ling-Na Kong: conception and design of this study, data analysis, and manuscript writing and revision; Ping Hu: data collection, data analysis, manuscript revision; Dun-Xiu Liu: data collection and manuscript revision. All authors read and approved the final manuscript.

Acknowledgements

We are grateful to all experts for their involvement in the Delphi consultation.

Leegaard M, Utne I, Halvorsrud L, Valeberg BT, Torbjørnsen A, Bjørnnes AK et al. A review of self-rated generic quality of life instruments used among older patients receiving home care nursing. Health Soc Care Community. 2018; 26(3):e321-e328.
Palesy D, Jakimowicz S. Home care in Australia: an integrative review. Home Health Care Serv Q. 2018; 37(2):113-139.
Han SJ, Kim HK, Storfjell J, Kim MJ. Clinical outcomes and quality of life of home health care patients. Asian nursing research. 2013; 7(2):53-60.
Padula MS, D'Ambrosio GG, Tocci M, D'Amico R, Banchelli F, Angeli L et al. Home care for heart failure: can caregiver education prevent hospital admissions? a randomized trial in primary care. J Cardiovasc Med (Hagerstown). 2019; 20(1):30-38.
Ugur HG, Erci B. The effect of home care for stroke patients and education of caregivers on the caregiver burden and quality of life. Acta Clin Croat. 2019; 58(2):321-332.
Nikbakht Nasrabadi A, Shahsavari H, Almasian M, Heydari H, Hazini A. Designing a process model of home care service delivery in Iran: a mixed methods study. Int J Community Based Nurs Midwifery. 2019; 7(4):288-299.
Chen WJ, Wang F, Ding YD, Chen H, Zhang LP, Wang Y. The practice and experience of home nursing under the construction of homogeneity in medical alliance. Chin Hosp. 2019; 23(10):61-63.
Tian YN, Shi ZX. Analysis and countermeasures of status quo of home care in China. Chin Gen Pract Nurs. 2015; 13(4):304-305.
Tang X, Chen X, Wu B, Ma C, Ge S, Sun H et al. Where are we and what shall we do next? a qualitative study of the quality of home care in Shanghai, China. J Transcult Nurs. 2020:1043659620911965.
O'Connor M, Davitt JK. The Outcome and Assessment Information Set (OASIS): a review of validity and reliability. Home Health Care Serv Q. 2012; 31(4):267-301.
Foebel AD, van Hout HP, van der Roest HG, Topinkova E, Garms-Homolova V, Frijters D et al. Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs). BMC Geriatr. 2015; 15:148.
Wagner A, Schaffert R, Mockli N, Zuniga F, Dratva J. Home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC): a systematic review. BMC Health Serv Res. 2020; 20(1):366.
Hercos BVS, Berezovsky A. Quality of the ophthalmological service to outpatients of the public and private healthcare systems. Arq Bras Oftalmol. 2017; 80(6):350-354.
Shaller D, Sofaer S, Findlay SD, Hibbard JH, Lansky D, Delbanco S. Consumers and quality-driven health care: a call to action. Health Aff (Millwood). 2003; 22(2):95-101.
Rezaei S, Hajizadeh M, Zandian H, Fathi A, Nouri B. Service quality in Iranian hospitals: a systematic review and meta-analysis. Med J Islam Repub Iran. 2018; 32:59.
Fatima I, Humayun A, Iqbal U, Shafiq M. Dimensions of service quality in healthcare: a systematic review of literature. Int J Qual Health Care. 2019; 31(1):11-29.
Bobocea L, Gheorghe IR, Spiridon S, Gheorghe CM, Purcarea VL. The management of health care service quality. a physician perspective. J Med Life. 2016; 9(2):149-152.
Alexandridou M, Vorreakou L, Galanakis A, Theodorou G, Stauropoulos E, Kelesi M et al. Public hospital quality assessment. Evidence from Greek health setting using SERVQUAL model. Int J Environ Res Public Health. 2021; 18(7):3418.
Matthews BL, Daigle J. Bridging the dichotomous gap between expectations and perceptions in quantifying hospice care quality. Health Mark Q. 2019; 36(3):236-253.
Kashfi SM, Karimian E, Ravangard R, Mehralian G, Bastani P. Service quality in outpatient teaching hospital pharmacies based on the SERVQUAL model: An assessment in the south of Iran. Int J Pharm Pract. 2022; 30(2):153-159.
Rocha J, Pinto A, Batista M, Paula JS, Ambrosano G. The importance of the evaluation of expectations and perceptions to improve the dental service quality. Int J Health Care Qual Assur. 2017; 30(6):568-576.
Leverton M, Burton A, Rees J. A systematic review of observational studies of adult home care. Health Soc Care Community. 2019; 27(6):1388-1400.
Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011; 6(6):e20476.
Custer RL, Scarcella JA, Stewart BR. The modified Delphi technique - a rotational modification. Journal of Vocational and Technical Education. 1999; 15(2).
Schmidt K, Aumann I, Hollander I, Damm K, von der Schulenburg JM. Applying the Analytic Hierarchy Process in healthcare research: a systematic literature review and evaluation of reporting. BMC Med Inform Decis Mak. 2015; 15:112.
Wu SW, Chen T, Pan Q, Wei LY, Wang Q, Li C et al. Establishment of a quantitative medical technology evaluation system and indicators within medical institutions. Chin Med J (Engl). 2018; 131(11):1327-1332.
Jiang F, Liu T, Zhou H, Rakofsky JJ, Liu H, Liu Y et al. Developing medical record-based, healthcare quality indicators for psychiatric hospitals in China: a modified Delphi-Analytic Hierarchy Process study. Int J Qual Health Care. 2019; 31(10):733-740.
Dai F, Wei K, Chen Y, Ju M. Construction of an index system for qualitative evaluation of undergraduate nursing students innovative ability: A Delphi study. J Clin Nurs. 2019; 28(23-24):4379-4388.
Tang X, Chen X. Where Are We and What Shall We Do Next? A Qualitative Study of the Quality of Home Care in Shanghai, China. 2020:1043659620911965.
Jarling A, Rydström I, Ernsth-Bravell M, Nyström M, Dalheim-Englund AC. Becoming a guest in your own home: Home care in Sweden from the perspective of older people with multimorbidities. Int J Older People Nurs. 2018; 13(3):e12194.
Wang LT, Tang LJ, Yue LC, Li YH, Xu XH, Zhao YQ et al. The study on work experience of nurses in internet home-care service. Chin J Nurs. 2020; 55(2):1067-1071.
Tang X, Ge S, Ma C, Chen X, Pei Y, Zhou L et al. Evaluating the quality of home care in China using the Home Care Quality Assessment Tool. J Transcult Nurs. 2020:1043659620953191.
Dostálová V, Bártová A. The needs of older people receiving home care: a scoping review. Aging Clin Exp Res. 2020.
Ganann R, Weeres A, Lam A, Chung H, Valaitis R. Optimization of home care nurses in Canada: a scoping review. Health Soc Care Community. 2019; 27(5):e604-e621.

No competing interests reported.

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Identifying quality indicators for home care services: a modified Delphi and Analytic Hierarchy Process study

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Abstract

Background

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Conclusion

Background

Methods

Design

Experts panel

Questionnaire preparation

Data collection

Ethical considerations

Data analysis

Results

Characteristics of experts

Round one

Round two

Coordination of expert opinions

Relative importance of indicators

Discussion

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Conclusion

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