Development of a three-dimensional evaluation system for outpatient healthcare quality in stomatological hospitals

To develop a three-dimensional (structure-process-outcome) evaluation index system for outpatient healthcare quality tailored to the "large outpatient, small inpatient" operational characteristics of stomatological hospitals in China, addressing the current monitoring gap of over-reliance on outcome measures while neglecting structural and process dimensions.

A mixed-methods design was employed. Initial dimensions were established through systematic literature review and focus group discussions (n = 8). A two-round Delphi expert consultation was conducted with 28 specialists (authority coefficient Cr = 0.824; response rates: 87.5% → 100%) to select indicators using threshold criteria (importance score ≥4.0, coefficient of variation ≤0.25). The Analytic Hierarchy Process was used to calculate indicator weights, and Cronbach's α coefficient was applied to assess reliability.

The final index system comprised 3 first-level indicators, 16 s-level indicators, and 77 third-level indicators. First-level indicator weights were: process quality (0.340) > outcome quality (0.333) > structural quality (0.328), with a consistency ratio CR = 0.041. The highest-weighted third-level indicator was outpatient medical record writing qualification rate (0.044). Expert coordination coefficients improved from 0.209 (first round) to 0.365 (second round) (p < 0.001). Cronbach's α coefficients for all dimensions ranged from 0.604 to 0.975.

By shifting quality control checkpoints forward to the care delivery process (highest weight assigned to process quality), this index system facilitates a paradigm shift from "post-hoc remediation" to "proactive prevention" in quality management. It provides an evidence-based tool for standardized quality evaluation, cross-regional benchmarking, and quality monitoring under DRG/DIP payment reforms in stomatological hospitals, offering significant public health administration value.