Identifying the Service Capability of Long-Term Care Facilities in China: An e-Delphi Study

Development of a social learning theory-based pressure injury training program for nursing assistants in Chinese nursing homes

Introduction

Pressure injury (PI) is a significant concern in Chinese nursing homes, particularly in China, especially due to the rapidly aging population. Nursing assistants play a vital role in PI prevention and management but often lack adequate training. To address this gap, we developed a training program for nursing assistants based on Social Learning Theory (SLT), aimed at improving their competencies in PI prevention and management. The modified Delphi method was used to gather expert consensus on the program's structure and content.

Methods

A two-round Delphi process was performed involving an expert panel in wound care, community nursing, geriatric nursing, and nursing education. The training program was designed based on SLT, emphasizing observational learning, enactive learning, and behavioral reinforcement. Several experts evaluated the training program's content, which was informed by systematic reviews and qualitative interviews with stakeholders. Data analysis included expert's positive coefficient, expert's authority coefficient (Cr), expert's coordination coefficient (Kendall's W), and coefficient of variation (CV) were used to reflect reliability and consensus.

Results

Consensus was reached on 79 key indicators for the training program, which included 4 first-level indicators (training objectives, content, methods, and evaluation), 13 second-level indicators, and 62 third-level indicators. The expert authority coefficient was 0.93, and Kendall's W values of 0.372 (p < 0.001) in the first round and 0.177 (p < 0.001) in the second round indicated strong agreement among experts. The program integrates SLT principles, such as attention, retention, motor reproduction, and motivation, to enhance the training's effectiveness.

Conclusion

The study developed a comprehensive SLT-based PI training program for nursing assistants in Chinese nursing homes using the modified Delphi method. The program addresses the critical need for competency-based training in PI prevention and management. Future research should focus on the implementation and evaluation of this program in real-world settings to determine its effectiveness in improving nursing assistants' skills and reducing PI incidence among older adult residents.

Construction of the medical virtual teaching and research office evaluation system in China based on the context, input, process, product model: a Delphi study

BACKGROUND

As new-formed basic-level teaching organizations, medical virtual teaching and research offices (VTROs) have been established in China since 2021. There still a lack of a comprehensive standard for them. The aim of this study was to construct a comprehensive system for evaluation of the medical VTROs.

METHODS

The authors developed an initial draft of the VTROs evaluation system, based on the context, input, process, product model and a literature review. A total of 19 experts were invited to provide supportive advice and modification suggestions on the evaluation system in two Delphi rounds, and calculated coefficient value, consistency ratio, and weight for each first-, second-, and third-level indices.

RESULTS

The CIPP model-based evaluation system developed included the subject and course categories. The subject category had 4 first-level indices, 14 s-level indices, and 46 third-level indices, while the course category had 4 first-level indices, 13 s-level indices, and 49 third-level indices. The recovery rates for two rounds were 94.7% and 89.5%. Coefficient value for the two subscales ranged from 0.097 to 0.207 in the second round, while weighted quality index values were established at all levels, with a consistency ratio < 0.1.

CONCLUSIONS

The VTROs evaluation system is CIPP-oriented, comprehensive, and reliable. It can serve a guide for construction, implementation, and evaluation of VTROs in medical field.

Estimating weight for multidimensional health poverty using Delphi method and analytic hierarchy process: a case of China

BACKGROUND

Traditionally, poverty assessment has relied on a single income criterion, which is inadequate in contexts where absolute poverty has been mitigated. This study developed a weighting scheme for the Multidimensional Health Poverty Index (MHPI) based on sustainable livelihood framework (SLF), aimed at enhancing the accuracy of poverty identification in China.

METHODS

A two-round Delphi process was used to determine the indicators of the index system. The weight of each indicator was calculated using the analytic hierarchy process (AHP) method. The multidimensional poverty index incorporates SLF's five dimensions: financial, natural, physical, social, and human capital.

RESULTS

The initial 46 indicators formed an indicator pool for the Delphi questionnaire. Based on the final consensus of the expert panel, the Delphi consultation resulted in an index system comprising six first-level and 23 second-level indicators. The weight values of the first-level indicators (economic security, health status, education, social capital, healthcare utilisation, and living conditions) were 0.2715, 0.2593, 0.0855, 0.0657, 0.1812, and 0.1363, respectively.

CONCLUSION

This study established a scientific and effective index to evaluate generate weight for estimating multidimensional health poverty in China. Economic security, health status, and healthcare utilisation are the most crucial aspects of multidimensional health poverty. Moreover, the results indicated that vocational training and social capital should be emphasised.

Development of an index system for the scientific literacy of medical staff: a modified Delphi study in China

BACKGROUND

Scientific research activity in hospitals is important for promoting the development of clinical medicine, and the scientific literacy of medical staff plays an important role in improving the quality and competitiveness of hospital research. To date, no index system applicable to the scientific literacy of medical staff in China has been developed that can effectively evaluate and guide scientific literacy. This study aimed to establish an index system for the scientific literacy of medical staff in China and provide a reference for improving the evaluation of this system.

METHODS

In this study, a preliminary indicator pool for the scientific literacy of medical staff was constructed through the nominal group technique (n = 16) with medical staff. Then, two rounds of Delphi expert consultation surveys (n = 20) were conducted with clinicians, and the indicators were screened, revised and supplemented using the boundary value method and expert opinions. Next, the hierarchical analysis method was utilized to determine the weights of the indicators and ultimately establish a scientific literacy indicator system for medical staff.

RESULTS

Following expert opinion, the index system for the scientific literacy of medical staff featuring 2 first-level indicators, 9 second-level indicators, and 38 third-level indicators was ultimately established, and the weights of the indicators were calculated. The two first-level indicators were research literacy and research ability, and the second-level indicators were research attitude (0.375), ability to identify problems (0.2038), basic literacy (0.1250), ability to implement projects (0.0843), research output capacity (0.0747), professional capacity (0.0735), data-processing capacity (0.0239), thesis-writing skills (0.0217), and ability to use literature (0.0181).

CONCLUSIONS

This study constructed a comprehensive scientific literacy index system that can assess medical staff's scientific literacy and serve as a reference for evaluating and improving their scientific literacy.

Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study

INTRODUCTION

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.

AIM

To develop a list of medications to facilitate appropriate prescribing among older adults.

METHODS

A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.

RESULTS

The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.

CONCLUSIONS

The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study

OBJECTIVE

Nonhuman primates (NHPs) are suitable for being model animals in the study of consciousness and loss of consciousness (LoC) with a similar brain structure and function to humans. However, there is no effective consciousness assessment scale for them. This study aimed to develop a behavioral assessment scale of consciousness for NHPs.

METHODS

We constructed an initial indicator framework based on the clinical consciousness disorder assessment scales and the physiological characteristics, consciousness, and arousal behavior of NHPs. A two-round online Delphi method was conducted by a multidisciplinary expert panel to construct a behavioral assessment scale of consciousness for NHPs. The indicators and descriptions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. The accepted competencies of indicators were established with mean scores in two scoring criteria (importance and feasibility) ≥4.0, agreement rate with a rating of importance or essential ≥70.0%, and a coefficient of variation ≤0.25, as well as discussions of the research group.

RESULTS

Consensus was achieved after the second round of consultations, which was completed by 28 experts who specialized in rehabilitation, neuroscience, psychology, neurosurgery, and neurology. A new behavioral assessment scale of consciousness for NHPs, including 37 items organized hierarchically within seven dimensions including visual function, auditory function, motor function, orofacial movements, arousal, brainstem reflexes, and respiration, was developed in this study.

CONCLUSIONS

This study has successfully developed a behavioral assessment scale for measuring the conscious state of NHPs or NHP models with LoC. This tool is expected to facilitate future research into the underlying mechanisms of consciousness by providing a detailed and comprehensive means of measurement.

Utilization and performance of long-term care system for older people with disabilities and dementia in Zhejiang Province, China

Introduction

To explore changes in performance, weaknesses, and utilization of the long-term care (LTC) system for older people with disabilities and dementia (OPWDD) in Zhejiang Province, China, thereby providing a reference for decision-making amid a progressively aging population.

Methods

A performance evaluation model of the LTC system for OPWDD was constructed using three dimensions: input, process, and outcome. Performance indicators and trends were calculated based on data collected from statistical yearbooks, documents, and work reports of the Bureau of Statistics and other government departments in Zhejiang Province, China, published in 2015-2021.

Results

Significant improvements were observed in most LTC performance indicators for OPWDD, such as input, process, and outcome, with notable enhancements in fairness, accessibility, and affordability of LTC services. By 2021, there were 6.20 nursing and rehabilitation beds in medical institutions and 3.77 general practitioners per 1,000 people aged 65 and above, up 144.14% and 13.73%, respectively, from 2015. The rate of health management for older people was 70.91%, representing a 10.33% increase from 2015. The actual reimbursement ratio of hospitalization expenses covered by basic medical insurance for older people rose 7.05%, from 72.76% in 2015 to 77.89% in 2021. Social security satisfaction rose 12.4%, from 71.3% in 2015 to 83.7% in 2021. Certain indicators, however, showed no significant improvement and tended to decline, such as the number of beds at older care institutions and caregivers per 1,000 people aged 65 and over.

Discussion

It is imperative to further balance the allocation of care resources, using a people-centered and integrated LTC system. The proportion of rehabilitation and nursing beds for older people should be consistently increased to effectively alleviate the shortage of care beds. Furthermore, a talent incentive policy should be improved to train caregivers and provide whole-person and whole-life course care based on OPWDD needs.