Tossaint-Schoenmakers Rosian, Kasteleyn Marise J, Rauwerdink Anneloek, Chavannes Niels, Willems Sofie, Talboom-Kamp Esther P W A
Saltro Diagnostic Centre, Unilabs Netherlands, Utrecht, Netherlands.
National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.
JMIR Form Res. 2022 Jul 7;6(7):e38683. doi: 10.2196/38683.
Working with eHealth requires health care organizations to make structural changes in the way they work. Organizational structure and process must be adjusted to provide high-quality care. This study is a follow-up study of a systematic literature review on optimally organizing hybrid health care (eHealth and face to face) using the Donabedian Structure-Process-Outcome (SPO) framework to translate the findings into a modus operandi for health care organizations.
This study aimed to develop an SPO-based quality assessment model for organizing hybrid health care using an accompanying self-assessment questionnaire. Health care organizations can use this model and a questionnaire to manage and improve their hybrid health care.
Concept mapping was used to enrich and validate evidence-based knowledge from a literature review using practice-based knowledge from experts. First, brainstorming was conducted. The participants listed all the factors that contributed to the effective organization of hybrid health care and the associated outcomes. Data from the brainstorming phase were combined with data from the literature study, and duplicates were removed. Next, the participants rated the factors on importance and measurability and grouped them into clusters. Finally, using multivariate statistical analysis (multidimensional scaling and hierarchical cluster analysis) and group interpretation, an SPO-based quality management model and an accompanying questionnaire were constructed.
All participants (n=39) were familiar with eHealth and were health care professionals, managers, researchers, patients, or eHealth suppliers. The brainstorming and literature review resulted in a list of 314 factors. After removing the duplicates, 78 factors remained. Using multivariate statistical analyses and group interpretations, a quality management model and questionnaire incorporating 8 clusters and 33 factors were developed. The 8 clusters included the following: Vision, strategy, and organization; Quality information technology infrastructure and systems; Quality eHealth application; Providing support to health care professionals; Skills, knowledge, and attitude of health care professionals; Attentiveness to the patient; Patient outcomes; and Learning system. The SPO categories were positioned as overarching themes to emphasize the interrelations between the clusters. Finally, a proposal was made to use the self-assessment questionnaire in practice, allowing measurement of the quality of each factor.
The quality of hybrid care is determined by organizational, technological, process, and personal factors. The 33 most important factors were clustered in a quality management model and self-assessment questionnaire called the Hybrid Health Care Quality Assessment. The model visualizes the interrelations between the factors. Using a questionnaire, each factor can be assessed to determine how effectively it is organized and developed over time. Health care organizations can use the Hybrid Health Care Quality Assessment to identify improvement opportunities for solid and sustainable hybrid health care.
开展电子健康服务要求医疗机构在工作方式上做出结构性改变。必须调整组织结构和流程以提供高质量护理。本研究是一项对系统文献综述的后续研究，该综述使用多纳贝迪安结构 - 过程 - 结果（SPO）框架对混合医疗保健（电子健康和面对面医疗）进行优化组织，以便将研究结果转化为医疗机构的运作方式。
本研究旨在使用随附的自我评估问卷开发一个基于SPO的混合医疗保健组织质量评估模型。医疗机构可以使用此模型和问卷来管理和改进其混合医疗保健服务。
概念映射用于通过结合专家基于实践的知识来丰富和验证文献综述中基于证据的知识。首先，进行头脑风暴。参与者列出了有助于有效组织混合医疗保健及其相关结果的所有因素。头脑风暴阶段的数据与文献研究的数据相结合，并去除重复项。接下来，参与者对这些因素的重要性和可衡量性进行评分，并将它们分组。最后，使用多元统计分析（多维尺度分析和层次聚类分析）和小组解读，构建了一个基于SPO的质量管理模型和一份随附的问卷。
所有参与者（n = 39）都熟悉电子健康服务，并且是医疗保健专业人员、管理人员、研究人员、患者或电子健康服务供应商。头脑风暴和文献综述产生了一份包含314个因素的清单。去除重复项后，剩下78个因素。通过多元统计分析和小组解读，开发了一个包含8个聚类和33个因素的质量管理模型和问卷。这8个聚类包括：愿景、战略和组织；优质信息技术基础设施和系统；优质电子健康应用；为医疗保健专业人员提供支持；医疗保健专业人员的技能、知识和态度；对患者的关注；患者结果；以及学习系统。SPO类别被定位为总体主题，以强调各聚类之间的相互关系。最后，提出了在实践中使用自我评估问卷的建议，以便能够衡量每个因素的质量。
混合医疗保健的质量由组织、技术、流程和个人因素决定。33个最重要的因素被聚类到一个名为混合医疗保健质量评估的质量管理模型和自我评估问卷中。该模型直观展示了各因素之间的相互关系。通过使用问卷，可以评估每个因素，以确定其随着时间的推移在组织和发展方面的有效性。医疗机构可以使用混合医疗保健质量评估来识别改进机会，以实现稳固且可持续的混合医疗保健服务。
