Data_Sheet_2_Digital health and quality of care in Primary Health Care: an evaluation model.PDF

IntroductionThe implementation of technologies in Primary Health Care with monitoring and evaluation of the quality of health care is fundamental to direct the access and quality of health care in the context of the Sustainable Development Goals. Our objective was to develop a model for evaluating digital health interventions in primary care, considering its impact on first contact, longitudinality, integrality and coordination in health.
MethodologyThis is an exploratory methodological study of a qualitative nature. This study seeks to explore strategic actors’ perceptions of an evaluation model, and was developed in a process between June 2021 and March 2024. The following stages were followed: Identification of previous models available in the literature, model development, model validation, model update. We performed a nominal group consensus technique online with seven experts. Stages taken to define the design of the model: sending the elaborated model, together with an electronic form with 18 subjective questions, such as brainstorming strategy, for recording impressions, judgment of agreement and suggestions; workshop for discussion by videoconference, at the time the objectives and the model diagram were presented, followed by debate with clarification of doubts and suggestions for clarification of the step-by-step design. After incorporating the suggestions, the model agreed upon in the workshop was subjected to another analysis by the same experts, sent in an online Google document, in which possible inconsistencies between the proposed model and the agreed one were verified, as well as the final agreement on the recommended proposal. At the end of this stage, with synchronous and asynchronous remote procedures, consensus was reached.
ResultsThe proposed evaluation model presents as primary categories, structure, process and result. The structure encompasses four indicators, namely, employees; financial resources; infrastructure resources; and regulatory and strategic resources. The process is organized into three dimensions, namely: technical dimension, organizational dimension and relational dimension. The results will be evaluated in products; intermediate results; and impacts (short, medium and long term). The results will be measured by the seven pillars of quality: efficacy, effectiveness, efficiency, optimization, acceptability, legitimacy, equity.
ConclusionThis study achieved the goal of developing a model to evaluate digital health interventions in Primary Health Care, helping to identify adequate and useful evaluation methods filling the gap of the lack of quality evaluation standards in the brazilian Digital Health Strategy. It presents an important difference in relation to models from different countries, as it considers the impacts on Primary Health Care quality attributes such as first contact care, longitudinality, integrality and coordination of care. The model will be used by managers and health professionals of Primary Health Care in a case study in Brazil to evaluate the quality of health care. It is expected that the proposed model may be used in other evaluation studies and countries through contextual adaptations.

引言
在可持续发展目标（Sustainable Development Goals）框架下，于初级卫生保健（Primary Health Care）领域应用技术并开展医疗质量监测与评估，对于引导医疗服务可及性与质量提升至关重要。本研究旨在构建一款适用于初级卫生保健场景的数字健康干预评估模型，重点考量其对医疗首诊服务、连续性、整体性与协同性的影响。

研究方法
本研究为质性探索性方法学研究，旨在探索战略参与者对某评估模型的认知，研究周期为2021年6月至2024年3月。研究遵循以下流程：梳理文献中已有的评估模型、构建评估模型、开展模型验证、进行模型迭代更新。本研究采用线上名义小组共识技术（nominal group consensus technique），邀请7位专家参与。模型设计的具体步骤如下：首先向专家发送已初步构建完成的模型，同时附带一份包含18道主观问题的电子问卷，问卷设置头脑风暴环节，用于记录参与者的初步印象、同意程度判断与改进建议；随后通过视频会议开展研讨工作坊，会上先介绍研究目标与模型架构图，随后展开讨论以澄清疑问并细化分步设计方案。在整合所有建议后，将工作坊中达成初步共识的模型交由同一批专家通过在线谷歌文档开展二次分析，核验拟议模型与共识模型间的潜在不一致之处，并就最终推荐方案达成一致。通过上述同步与异步结合的远程流程，本阶段最终达成共识。

研究结果
本研究提出的评估模型包含三大核心一级类别，即结构、过程与结果。其中结构维度涵盖四项指标：人员队伍、财务资源、基础设施资源，以及监管与战略资源。过程维度则分为三大维度：技术维度、组织维度与关系维度。结果维度则从产出、中间结果与长中短期影响三个层面开展评估。结果指标将通过七大质量支柱进行衡量：效力（efficacy）、效果（effectiveness）、效率（efficiency）、最优化（optimization）、可接受性（acceptability）、合法性（legitimacy）与公平性（equity）。

结论
本研究成功达成了构建初级卫生保健领域数字健康干预评估模型的目标，助力筛选适配且实用的评估方法，填补了巴西数字健康战略（Brazilian Digital Health Strategy）中医疗质量评估标准缺失的空白。本模型与其他国家的同类模型存在显著差异，因其充分考量了对初级卫生保健核心质量属性的影响，包括首诊服务、连续性、整体性与医疗协同性。该模型将由巴西初级卫生保健的管理人员与医护人员应用于一项案例研究，以评估医疗服务质量。本研究预期，通过适配不同场景的调整，该模型可推广应用于其他国家的同类评估研究中。