The development of a performance evaluation index system for internet hospitals in Qingdao, China: A Delphi consensus...

To integrate the Structure-Process-Outcome framework with the SERVQUAL model to develop a performance evaluation index system tailored for internet hospitals in Qingdao, China. This study provides a scientific tool for assessing and optimizing the service quality of internet hospitals.

Following the Structure-Process-Outcome framework and the SERVQUAL model, evaluation indicators were systematically collected through literature review and policy analysis. A preliminary index system was constructed and refined through two rounds of Delphi expert consultations. Experts from hospitals, universities, and research institutions in Qingdao, Nanjing, and Lianyungang participated, providing ratings and recommendations. The research team assessed questionnaire reliability, expert positivity, expert authority, and opinion consistency using statistical methods, including Cronbach's coefficient alpha, authority coefficient, and Kendall's coefficient of concordance W.

The preliminary index system identified through literature review and a pre-survey included three primary, seven secondary, and 28 tertiary indicators. After Delphi Round 1, some indicators were revised, three tertiary indicators were added, and no indicators were removed. After Delphi Round 2, further revisions were made, and the consultation was concluded when the p value of the test for Kendall's coefficient of concordance W was <0.001 and the coefficient of variation was within acceptable limits (<0.3). The final index system comprises three primary, seven secondary, and 31 tertiary indicators. The overall Cronbach's coefficient alpha was 0.962, with values of 0.903, 0.903, and 0.857 for the three primary dimensions, indicating high reliability. The authority coefficient was 0.885, all above the 0.7 threshold. Kendall's coefficient of concordance W values for secondary and tertiary indicators in the second round were 0.286 and 0.285 (all p < 0.001), reflecting moderate consensus among experts.

This study provides a practical, outcome-oriented, security-first tool for promoting high-quality development of internet hospitals in China, with potential applicability to similar settings. This study contributes by explicitly integrating Structure-Process-Outcome and SERVQUAL into a unified framework, enabling simultaneous assessment and optimization of process quality and multidimensional service quality in internet hospitals.