Guzmán-Leguel Yisel Mi, Rodríguez-Lara Simón Quetzalcoatl
School of Medicine, Universidad Autónoma de Guadalajara, Zapopan 45129, Jalisco, Mexico.
Healthcare (Basel). 2025 Jul 16;13(14):1714. doi: 10.3390/healthcare13141714.
Assessing the quality of patient care within healthcare systems remains a multifaceted challenge due to varying definitions of "quality" and the complexity of care delivery structures worldwide. Patient-centeredness, institutional responsiveness, and contextual adaptability are increasingly recognized as core pillars in quality assessment. Objective: This narrative literature review aims to explore conceptual models and practical frameworks for evaluating healthcare quality, emphasizing tools that integrate technical, functional, and emotional dimensions and proposing a comprehensive model adaptable to diverse health system contexts. A systematic literature search was conducted in the PubMed, Scopus, and Cochrane Library databases, covering the years 2000 to 2024. Studies were selected based on relevance to quality assessment models, patient satisfaction, accreditation, and strategic improvement methodologies. The review followed a thematic synthesis approach, integrating structural, process-based, and outcome-driven perspectives. Core frameworks such as Donabedian's model and balancing measures were reviewed alongside evaluation tools like the Dutch Consumer Quality Index, SERVQUAL, and Importance-Performance Analysis (IPA). These models revealed significant gaps between patient expectations and actual service delivery, especially in functional and emotional quality dimensions. This review also identified limitations related to contextual generalizability and bias. A novel integrative model is proposed, emphasizing the dynamic interaction between institutional structure, clinical processes, and patient experience. High-quality healthcare demands a multidimensional approach. Integrating conceptual frameworks with context-sensitive strategies enables healthcare systems to align technical performance with patient-centered outcomes. The proposed model offers a foundation for future empirical validation, particularly in resource-limited or hybrid settings.
由于“质量”的定义各不相同，且全球医疗服务提供结构复杂，评估医疗系统内的患者护理质量仍然是一个多方面的挑战。以患者为中心、机构响应能力和情境适应性日益被视为质量评估的核心支柱。目的：本叙述性文献综述旨在探索评估医疗质量的概念模型和实用框架，强调整合技术、功能和情感维度的工具，并提出一个适用于不同卫生系统背景的综合模型。在PubMed、Scopus和Cochrane图书馆数据库中进行了系统的文献检索，涵盖2000年至2024年。根据与质量评估模型、患者满意度、认证和战略改进方法的相关性选择研究。该综述采用主题综合方法，整合基于结构、过程和结果驱动的观点。对诸如唐纳贝迪安模型和平衡措施等核心框架以及荷兰消费者质量指数、SERVQUAL和重要性-绩效分析（IPA）等评估工具进行了综述。这些模型揭示了患者期望与实际服务提供之间的重大差距，尤其是在功能和情感质量维度。本综述还确定了与情境普遍性和偏差相关的局限性。提出了一种新颖的综合模型，强调机构结构、临床过程和患者体验之间的动态相互作用。高质量的医疗保健需要多维方法。将概念框架与情境敏感策略相结合，使医疗系统能够将技术性能与以患者为中心的结果保持一致。所提出的模型为未来的实证验证提供了基础，特别是在资源有限或混合环境中。
