背景:在医疗保健系统性能的测量方面已经有了显着扩展。然而,缺乏全面的绩效评估框架来评估电话分诊服务对紧急护理系统的影响。我们的Delphi研究的目的是构建和验证为电话分诊服务明确设计的绩效评估框架。
方法:这项研究是在芬兰进行的,由来自该国20个最大的联合急诊科的8名经验丰富的高级医师组成,为90%以上的人口提供紧急护理服务。标称组技术(NGT)用于在测量电话分诊性能方面达成共识。最初,绩效指标(PI)通过德尔菲法确定了12月10日至12月27日的轮次,2021年,有8位专家参与,从12月29日开始,2021年1月23日,2022年,其中五位专家做出了回应。NGT进一步深化了这些主题和观点,协助开发全面的绩效评估框架。最终的框架验证从2月13日至3月3日的第一轮开始,2022年,收到5份回复。由于回复数量有限,10月29日至11月7日进行了另一轮验证,2023年,导致了另外两个回应,将验证阶段的受访者总数增加到7人。
结果:该研究发现,专业人士强烈希望采用统一的框架来衡量电话分诊性能。最终确定的框架从五个方面评估电话分类:服务可访问性,患者体验,质量和安全,过程结果,和每个案例的成本。建立了八个具体的PI,包括呼叫响应指标,服务实用程序,后续护理类型和分布,ICPC-2分类相遇原因,患者对后续护理的依从性,评估期间的病史回顾,和每次通话的服务费用。
结论:本研究验证了电话分诊服务的性能测量框架,利用现有文献和NGT方法。该框架包括五个关键维度:患者体验,质量和安全,电话分诊过程的结果,每个案例的成本,8个PI它提供了一个结构化和全面的方法来衡量电话分诊服务的整体性能,提高我们有效评估这些服务的能力。
BACKGROUND: There has been a significant expansion in the measurement of healthcare system performance. However, there is a lack of a comprehensive performance measurement framework to assess the effects of telephone triage services on the urgent care system. The aim of our Delphi study was to construct and validate a performance measurement framework designed explicitly for telephone triage services.
METHODS: This study was conducted in Finland with a group of eight experienced senior physicians from the country\'s 20 largest joint emergency departments, serving over 90% of the population for urgent care. The Nominal Group Technique (NGT) was utilised to achieve consensus on measuring telephone triage performance. Initially, performance indicators (PIs) were identified through Delphi method rounds from December 10th to December 27th, 2021, with eight experts participating, and from December 29th, 2021, to January 23rd, 2022, where five of these experts responded. NGT further deepened these themes and perspectives, aiding in the development of a comprehensive performance measurement framework. The final framework validation began with an initial round from February 13th to March 3rd, 2022, receiving five responses. Due to the limited number of responses, an additional validation round was conducted from October 29th to November 7th, 2023, resulting in two more responses, increasing the total number of respondents in the validation phase to seven.
RESULTS: The study identified a strong desire among professionals to implement a uniform framework for measuring telephone triage performance. The finalised framework evaluates telephone triage across five dimensions: service accessibility, patient experience, quality and safety, process outcome, and cost per case. Eight specific PIs were established, including call response metrics, service utility, follow-up care type and distribution, ICPC-2 classified encounter reasons, patient compliance with follow-up care, medical history review during assessment, and service cost per call.
CONCLUSIONS: This study validated a performance measurement framework for telephone triage services, utilising existing literature and the NGT method. The framework includes five key dimensions: patient experience, quality and safety, outcome of the telephone triage process, cost per case, and eight PIs. It offers a structured and comprehensive approach to measuring the overall performance of telephone triage services, enhancing our ability to evaluate these services effectively.