Construction and empirical study on the dynamic evaluation system of nursing quality for day chemotherapy based on the Donabedian model
基于Donabedian模型的日间化疗护理质量动态评价体系构建与实证研究

摘要

目的 基于Donabedian的“结构-过程-结果”质量模型，构建适用于日间化疗的护理质量动态评价体系，并验证其临床应用效果。方法 于2025年3月启动研究，综合文献分析、流程追踪与多学科小组讨论，初步拟定指标体系。采用德尔菲专家函询法进行指标筛选与修订，并运用层次分析法确定各指标权重。将最终构建的体系应用于本院日间化疗单元的质量管理。通过对比应用前（2024年5月-2025年2月）86例与应用后（2025年3月-2025年12月）91例日间化疗患者的结局指标，评价实施效果。结果 构建的指标体系包含3项一级指标（结构、过程、结果）、10项二级指标和27项三级指标。专家权威系数为0.89，肯德尔和谐系数为0.76（P<0.01），权重分配合理。实证应用后，患者满意度由82.6%显著提升至93.4%，不良反应发生率由15.1%下降至7.7%，治疗依从性由78.9%提高至90.1%，差异均具有统计学意义（P<0.05）。结论 基于Donabedian模型构建的日间化疗护理质量动态评价体系具有科学性与可靠性，其应用能有效监测护理质量、引导针对性改进，从而提升患者结局与满意度，为日间化疗的规范化质量管理提供了实用工具。

Abstract

Objective Based on Donabedian's "structure-process-result" quality model, this study aimed to establish a dynamic nursing quality evaluation system applicable to day chemotherapy and validate its clinical application efficacy.
Methods The research was initiated in March 2025. A preliminary indicator system was developed through comprehensive literature analysis, process tracking, and multidisciplinary team discussions. The Delphi expert consultation method was employed for indicator screening and revision, while the analytic hierarchy process (AHP) was used to determine the weight of each indicator. The final system was implemented in the quality management of the day chemotherapy unit at our hospital. The implementation effect was evaluated by comparing outcome indicators of 86 day chemotherapy patients before implementation (May 2024-February 2025) with 91 patients after implementation (March 2025-December 2025).
Results The constructed indicator system comprised 3 primary indicators (structure, process, result), 10 secondary indicators, and 27 tertiary indicators. The expert authority coefficient was 0.89, and the Kendall harmony coefficient was 0.76 (P<0.01), indicating reasonable weight allocation. Empirical application demonstrated significant improvements: patient satisfaction increased from 82.6% to 93.4%, adverse reaction incidence decreased from 15.1% to 7.7%, and treatment adherence improved from 78.9% to 90.1%, all with statistically significant differences (P<0.05).
Conclusion   The dynamic evaluation system for nursing quality in day chemotherapy, constructed based on the Donabedian model, demonstrates scientific validity and reliability. Its application enables effective monitoring of nursing quality and facilitates targeted improvements, thereby enhancing patient outcomes and satisfaction. This system provides a practical tool for standardized quality management in day chemotherapy.