Li Xiaoyan, Zou Jihua, Hu Qiying, Li Rui, Gao Jingquan, Xu Linyan, Chen Jiajia, Tong Yingge, Chen Yubin
Medicine College, Lishui University, Lishui, Zhejiang, China.
Medical Education Department, Qingyuan County Hospital of Traditional Chinese Medicine, Lishui, Zhejiang Province, China.
BMC Geriatr. 2024 Dec 27;24(1):1041. doi: 10.1186/s12877-024-05638-2.
Standardized and systematic quality assessments of chronic pain management, particularly among older adult populations, are lacking in resource-limited community settings. A specific set of indicators to evaluate the quality of chronic pain management in this population has yet to be developed. Therefore, the present study constructed a set of indicators to assess the quality of chronic pain management in Chinese community-dwelling older adults, providing a standardized reference and guidance for community health centers to manage chronic pain in this population.
The indicator set was developed in three steps. Step 1 involved preparation by forming a research team and establishing the guiding theory. Step 2 included developing an expert inquiry questionnaire based on a literature review and semi-structured interviews. Step 3 completed the construction of the indicator set through the Delphi method and hierarchical analysis to quantify the relative importance of each indicator and ensure the development of a scientifically validated and practically applicable evaluation model.
The final set of indicators for evaluating the quality of chronic pain management among community-dwelling older adults in China comprised three primary indicators: structural quality indicator, process quality indicator, and outcome quality indicator. Structural quality indicators included 3 secondary and 11 tertiary indicators; process quality indicators included 4 secondary and 21 tertiary indicators; and outcome quality indicators included 2 secondary and 4 tertiary indicators. Across two rounds of questionnaires, the response rate was 100%, with expert authority coefficients of 0.924 and 0.938, coefficients of variation ranging from 0 to 0.32 and 0 to 0.20, and Kendall's concordance coefficients of 0.302 and 0.220, respectively. Hierarchical analysis showed that the consistency ratios of all indicators were < 0.1000, indicating a balanced distribution of indicator weights.
This study introduces a preliminary framework, based on the "Structure-Process-Outcome" theory, to evaluate chronic pain management in Chinese community-dwelling older adults. Its reliance on expert opinions without empirical validation, exclusion of patient perspectives, and focus on Chinese communities limit its applicability and generalizability. Future research should address these limitations by incorporating patient feedback, empirically validating indicators, and evaluating their applicability across diverse populations.
在资源有限的社区环境中，缺乏对慢性疼痛管理的标准化和系统性质量评估，尤其是在老年人群体中。尚未开发出一套用于评估该人群慢性疼痛管理质量的特定指标。因此，本研究构建了一套指标来评估中国社区居住老年人的慢性疼痛管理质量，为社区卫生中心管理该人群的慢性疼痛提供标准化参考和指导。
指标集分三步制定。第一步是通过组建研究团队和确立指导理论进行准备。第二步包括在文献综述和半结构化访谈的基础上制定专家调查问卷。第三步通过德尔菲法和层次分析法完成指标集的构建，以量化每个指标的相对重要性，并确保开发出科学验证且实际适用的评估模型。
中国社区居住老年人慢性疼痛管理质量评估的最终指标集包括三个主要指标：结构质量指标、过程质量指标和结果质量指标。结构质量指标包括3个二级指标和11个三级指标；过程质量指标包括4个二级指标和21个三级指标；结果质量指标包括2个二级指标和4个三级指标。在两轮问卷调查中，回复率均为100%，专家权威系数分别为0.924和0.938，变异系数范围为0至0.32和0至0.20，肯德尔和谐系数分别为0.302和0.220。层次分析表明，所有指标的一致性比率均<0.1000，表明指标权重分布均衡。
本研究引入了一个基于“结构 - 过程 - 结果”理论的初步框架，用于评估中国社区居住老年人的慢性疼痛管理。其依赖专家意见而未进行实证验证、排除患者观点以及专注于中国社区，限制了其适用性和普遍性。未来的研究应通过纳入患者反馈、对指标进行实证验证以及评估其在不同人群中的适用性来解决这些局限性。
