一项识别最有效的精神病院监管质量指标的离散选择实验。
A discrete choice experiment to identify the most efficient quality indicators for the supervision of psychiatric hospitals.
机构信息
Dutch Health and Youth Care Inspectorate, Ministry of Health, Welfare, and Sport, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands.
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
出版信息
BMC Health Serv Res. 2020 Mar 12;20(1):192. doi: 10.1186/s12913-020-4993-1.
BACKGROUND
In the Netherlands, health care is regulated by the Health and Youth Care Inspectorate. Forty-six indicators are used to prioritize supervision of psychiatric hospitals. The objective of this study is to define a smaller set of weighted indicators which reflects a consensus among inspectors about which aspects are most important for risk assessment.
METHODS
The set of 46 indicators, complemented with missing information, was reduced to six indicators by means of interviews, group discussions and ranking among the inspectors. These indicators were used as attributes in a discrete choice experiment (DCE) to define their weights.
RESULTS
Twenty-six inspectors defined the top four indicators suitable for the risk assessment of psychiatric hospitals. These are: the policy on prevention of compulsory treatment; the policy on dysfunctional professionals; the quality of internal research after a serious incident; and the implementation of multidisciplinary guidelines on suicidal behaviour. These indicators share the same importance with regard to risk assessment. The screening of somatic symptoms and the policy on integrated care are important indicators too, but less relevant.
CONCLUSION
Through a DCE, we reduced the amount of information for risk assessment of psychiatric hospitals to six weighted indicators. Inspectors can use these indicators to prioritize their inspections.
背景
在荷兰，医疗保健由卫生和青年保健监察局监管。使用 46 项指标对精神病院进行监督。本研究的目的是定义一组较小的加权指标，反映出监察员对哪些方面对风险评估最重要的共识。
方法
通过访谈、小组讨论和监察员排名，将 46 项指标（辅以缺失信息）减少到 6 项指标。这些指标被用作离散选择实验（DCE）的属性，以确定它们的权重。
结果
26 名监察员确定了适合精神病院风险评估的前四个指标。这些指标是：预防强制治疗的政策；功能失调专业人员的政策；严重事件后内部研究的质量；以及实施自杀行为的多学科指南。这些指标在风险评估方面具有同等重要性。躯体症状的筛查和综合护理政策也是重要的指标，但相关性较低。
结论
通过离散选择实验，我们将精神病院风险评估的信息量减少到六个加权指标。监察员可以使用这些指标来优先安排他们的检查。
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