Modified Delphi Consensus on Developing Home Care Service Quality Indicator for Stroke Survivor in Yogyakarta, Indonesia

Abstract

BACKGROUND: Assessing the quality of health services provided at home (home care) is a challenge. The formulation of indicators requires open-minded people, who able to formulate several purposes objectively, and play an active role in decision making.
 PURPOSE: To test the face validity of the home care quality indicator in stroke patients with the modified Delphi method.
 METHOD: Eighty-one indicators generated from previous studies were assessed using 3 processes to get the final results: 1) conducted modified Delphi in two rounds, namely rating or scoring by experts (using median scores); 2) reviewing qualitative suggestions from experts during the Delphi process (using comments from both Delphi rounds); 3) sorting out and correcting the grammar of the appropriate indicator (based on the median score > 7, and no disagreement).
 RESULT: Eighty-seven experts were involved in the first round Delphi and 34 experts in the second round. The experts were home care team selected from health care institutions in Yogyakarta with various professional backgrounds. Delphi process resulted in 67 indicators from 81 indicators which were divided into 10 domains: 1) Personal (2 indicators), 2) Documents (13 indicators), 3) Professionalism development (3 indicators), 4) Supporting facilities (8 indicators), 5) Administrative activities (4 indicators), 6) Health workers interaction with patients and families (15 indicators), 7) Physical conditions (2 indicators), 8) Self-actualization (1 indicator), 9) Psychological condition (5 indicators), 10) Family independent and coping (14 indicators). Selected indicators got to score more than 7 and no disagreement at all.
 CONCLUSION: Sixty-seven indicators of the quality of home care, which were generated from modified Delphi consensus, were face validated. Further research could be conducted particularly on the trial process of these indicators at the actual home dwelling service setting.

Validity and reliability testing of home care stroke quality indicators

“…Weight scales are included as one of the heavy equipment to carry and their use was difficult especially for patients who were bedridden. The results of this study contrast with the other research that include weight loss as one indicator of home care [11], [18], [19]. Weight loss data would be obtained for nutritional assessment for stroke patient.…”

“…The domain of psychological conditions is very important aspect in stroke patients because stroke patients often experience depression, mood disorders and social isolation [19], [27]- [29]. This is supported by another studies that include negative moods as an indicator of the quality of home care [11], [18], [19]. In addition, it is clearly explained that depression, anxiety and sadness are part of psychological indicators in the minimum data set-home care (MDS-HC) instrument.…”

“…Activities of daily living (ADL) ability and complications free are as an indicator of home care services [11], [18]. The importance of the ADL independence indicator can be seen from the expert's rating ISSN: 2252-8806  and the high score of loading factors.…”

“…On this basis, quality of home care organizations is a necessity [10]. To evaluate the effectiveness of interventions by home care officers, we need to have a standard assessment [11]. Quality of home care monitoring is not possible without any quality indicators [12].…”