Development of a Quality Assessment Index System for Palliative Care Services in Chinese Nursing Homes: A Modified...

As the population ages, nursing homes are key end-of-life care settings, making high-quality palliative care essential for safeguarding older adults' quality of life. However, China currently lacks a unified and systematic tool for evaluating the quality of palliative care services in nursing homes.

To develop a quality assessment index system for palliative care services tailored to Chinese nursing homes.

The study employed a mixed-methods design with three phases: (1) a literature review (40 studies, 36 policy/guideline documents; 2013-2023) and semistructured interviews with stakeholders from 6 nursing homes; (2) three rounds of modified Delphi expert consultation (n = 31, 27, 23) to revise and refine the indicators; and (3) application of the analytic hierarchy process (AHP) to determine indicator weights.

The final index system comprises 3 first-level, 22 second-level, and 47 third-level indicators. The expert authority coefficient (Cr) exceeded 0.85 across all consultation rounds. Expert consensus increased with each round (Kendall's W: 0.189 to 0.315, p < 0.05). AHP results indicated that among the first-level indicators, "process" had the highest weight (0.4114), followed by "structure" (0.3208) and "outcome" (0.2678). Within these dimensions, the highest weighted second-level indicators were "human resources planning and management" (0.0836), "comfort care services" (0.0861), and "quality of symptom management" (0.0438). Furthermore, key third-level indicators included "financial support and management" (0.0632), "basic nursing services" (0.0465), and "quality of symptom assessment and management" (0.0438).

This study developed a scientifically grounded quality assessment index system for palliative care services in Chinese nursing homes, which offers a preliminary framework for institutional self-evaluation and quality improvement efforts pending further empirical validation.

Once empirically validated, the framework may assist managers and staff in nursing homes to identify service gaps, optimize resource allocation, and support a shift toward an "older adult-centered" holistic care model.