ArticleBMC health services research2026
Development of an evaluation indicator system for wound care quality based on the structure-process-outcome model: a mixed-methods study.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAs population aging accelerates and the burden of chronic diseases increases, the incidence of chronic wounds such as diabetic foot ulcers and pressure injuries continues to rise. This trend not only worsens patient outcomes and quality of life but also strains the healthcare system. Traditional wound care assessments rely on isolated indicators, lack systematic monitoring, and fail to provide comprehensive evaluation throughout the care process, thereby limiting improvements in nursing quality. Based on Donabedian's structure-process-outcome framework, a thorough evaluation system can integrate key elements and multidimensional factors in wound care, supporting evidence-based, standardized nursing management.This study aims to develop a wound care quality evaluation indicator system designed to be clinically applicable and tailored to China's healthcare context, with the goal of promoting standardized practices and improved service quality.
methodsThis study used the "structure-process-outcome" model to develop a wound care quality evaluation system. In January 2025, initial indicators were identified via literature review and theoretical analysis. In February, semi-structured interviews refined and expanded the indicator pool. A preliminary draft was finalized after an internal team discussion. From March to April 2025, two rounds of expert consultation were conducted, with 27 experts participating in each via email. Data were analyzed using mean ± Standard Deviation (SD), coefficient of variation, and Kendall's W. Indicator weights were determined using the Analytic Hierarchy Process, yielding a final system with 3 first-level, 9 s-level, and 25 third-level indicators.
resultsThe effective response rates for both rounds of the questionnaire survey reached 100%. The authority coefficients for the experts were 0.874 and 0.889, respectively, indicating high expert reliability. Kendall's coefficient of concordance ranged from 0.169 to 0.181 in the first round and from 0.170 to 0.192 in the second round, reflecting a gradual improvement in consensus among experts. Ultimately, a wound care quality evaluation indicator system was established, comprising 3 first-level indicators, 9 s-level indicators, and 25 third-level indicators.
conclusionsThis indicator system is scientifically rigorous and reliable. It demonstrates theoretical potential for clinical applicability, as it is aligned with wound care practices and nursing management to objectively assess wound management quality. However, its practical operability and real-world applicability require further validation through clinical pilot studies. CLINICAL TRIAL NUMBER: Not applicable.
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