Development and Evaluation of Care Quality Indicators for Nursing Homes in China

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Ying Zhang
Sang-arun Isaramalai
Ploenpit Thaniwattananon


          This study aimed to develop a valid and reliable indicator for evaluating care quality provided to the assisted living Chinese elderly in nursing homes. The development phase included concept development, literature review and a qualitative approach using semi-structured interviews with 20 participants. The evaluation phase consisted of two steps, pretesting and final testing of its measurement properties, including content validity evaluation, inter-rater reliability assessment, and hypothesis testing.
          The results revealed three domains within the conceptual structure of nursing home care quality (NHCQ): culturally sensitive care, safe care environment, and self-care management, that covered four care aspects on activity and rest, nutrition and hydration, psychosocial health and wellness, special care and end of life care. The components of the NHCQI-China, I stands for Indicator, were classified by frequency of care action: on admission and regular basis. The items of NHCQI-China comprised: assessment, implementation, and evaluation with two choices as its criteria. The NHCQI-China obtained a Content Validity Index (CVI) of 0.93, the total percentage agreement of 89% verified reliability by inter-rater approach. The construct validity evaluation of the indicator, which used hypothesis testing on the differences in satisfaction scores rated by the elderly and displayed high and low care quality scores, was found to be significant (t = 5.737, p < 0.05). In conclusion, The newly developed NHCQI-China is able to provide a minimum data set of care quality for nursing homes and can be used to further develop care practice guidelines or care standards. This a tool might be beneficial for managing the care quality of nursing homes in China in the future.


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Zhang, Y., Isaramalai, S.- arun, & Thaniwattananon, P. (2020). Development and Evaluation of Care Quality Indicators for Nursing Homes in China. Songklanagarind Journal of Nursing, 40(2), 133-147. Retrieved from
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