Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Glob Health Action. 2024 Dec 31;17(1):2422170. doi: 10.1080/16549716.2024.2422170. Epub 2024 Nov 18.
Frameworks conceptualising the quality of care abound and vary; some concentrate on specific aspects such as safety, effectiveness, others all-encompassing. However, to our knowledge, tailoring to systematically arrive at a comprehensive care for chronic conditions quality (CCCQ) framework has never been done. We conducted a scoping review and Delphi survey to produce a CCCQ framework, comprehensively delineating aims, determinants and measurable attributes. With the assumption that specific groups (people with chronic conditions, care providers, financiers, policy-makers, etc.) view quality of care differently, we analysed 48 scientific and 26 grey literature deductively and inductively using the Institute of Medicine's quality of care framework as the foundation. We produced a zero-version of the quality of chronic care framework, detailing aims, healthcare system determinants, and measurement mechanisms. This was presented in a Delphi survey to 49 experts with diverse chronic care expertise/experience around the world. Consensus was obtained after the first round, with the panel providing suggestions and justifications to expand the agreed-upon components. Through this exercise, a comprehensive CCCQ framework encompassing the journey through healthcare of people with chronic conditions was developed. The framework specifies seven CCCQ 'aims' and identifies health system determinants which can be acted upon with 'organising principles' and measured through chronic care quality 'attributes' related to structures, processes and outcomes. Tailoring quality of care based on the nature of the diseases/conditions and considering different views can be done to ensure a comprehensive offer of healthcare services, and towards better outcomes that are acceptable to both the health system and people with chronic conditions (PwCC).
现有的照护质量概念框架层出不穷且各有不同；有些框架专注于安全性、有效性等特定方面，而另一些框架则包罗万象。然而，据我们所知，针对慢性疾病量身定制的全面照护质量（CCCQ）框架从未被构建过。我们开展了一项范围界定综述和德尔菲调查，以生成一个全面的 CCCQ 框架，明确界定目标、决定因素和可衡量的属性。鉴于特定群体（慢性疾病患者、照护提供者、资金提供者、政策制定者等）对照护质量的看法可能存在差异，我们使用美国医学研究所的照护质量框架作为基础，对 48 篇科学文献和 26 篇灰色文献进行了演绎和归纳分析。我们生成了一个慢性照护质量框架的零版本，详细说明了目标、医疗体系决定因素和测量机制。该框架在德尔菲调查中呈现给了来自世界各地、具有不同慢性照护专业知识/经验的 49 名专家。第一轮过后，专家小组达成了共识，并提出了扩展已达成共识部分的建议和依据。通过这项工作，我们开发了一个全面的 CCCQ 框架，涵盖了慢性疾病患者的整个照护过程。该框架具体说明了七个 CCCQ“目标”，并确定了可以通过“组织原则”来作用于的医疗体系决定因素，并通过与结构、过程和结果相关的慢性照护质量“属性”来进行衡量。基于疾病/状况的性质和考虑不同观点来定制照护质量，可以确保提供全面的医疗服务，并朝着更能被医疗体系和慢性疾病患者（PwCC）接受的结果努力。
