What question did this study set out to answer?

This research aims to create an evaluation index that measures outpatient healthcare quality considering structure, process, and outcomes in stomatological hospitals.

April 19, 2026Open Access

Development of a three-dimensional evaluation system for outpatient healthcare quality in stomatological hospitals

Key Points

This research aims to create an evaluation index that measures outpatient healthcare quality considering structure, process, and outcomes in stomatological hospitals.
Utilized mixed-methods design for developing initial index dimensions.
Conducted a two-round Delphi expert consultation with 28 specialists to select key indicators.
Applied Analytic Hierarchy Process to assign weights to indicators and conducted reliability testing using Cronbach’s alpha.
Developed an index system with 3 first-level indicators, 16 second-level indicators, and 77 third-level indicators.
Process quality received the highest weight (0.340), followed by outcome quality (0.333) and structural quality (0.328).
Achieved improvement in expert coordination coefficients from 0.209 to 0.365 between consultation rounds.

Abstract

Objective To develop a three-dimensional (structure-process-outcome) evaluation index system for outpatient healthcare quality tailored to the “large outpatient, small inpatient” operational characteristics of stomatological hospitals in China, addressing the current monitoring gap of over-reliance on outcome measures while neglecting structural and process dimensions. Methods A mixed-methods design was employed. Initial dimensions were established through systematic literature review and focus group discussions ( n = 8). A two-round Delphi expert consultation was conducted with 28 specialists (authority coefficient Cr = 0.824; response rates: 87.5% → 100%) to select indicators using threshold criteria (importance score ≥4.0, coefficient of variation ≤0.25). The Analytic Hierarchy Process was used to calculate indicator weights, and Cronbach’s α coefficient was applied to assess reliability. Results The final index system comprised 3 first-level indicators, 16 s-level indicators, and 77 third-level indicators. First-level indicator weights were: process quality (0.340) outcome quality (0.333) structural quality (0.328), with a consistency ratio CR = 0.041. The highest-weighted third-level indicator was outpatient medical record writing qualification rate (0.044). Expert coordination coefficients improved from 0.209 (first round) to 0.365 (second round) ( p 0.001). Cronbach’s α coefficients for all dimensions ranged from 0.604 to 0.975. Conclusion By shifting quality control checkpoints forward to the care delivery process (highest weight assigned to process quality), this index system facilitates a paradigm shift from “post-hoc remediation” to “proactive prevention” in quality management. It provides an evidence-based tool for standardized quality evaluation, cross-regional benchmarking, and quality monitoring under DRG/DIP payment reforms in stomatological hospitals, offering significant public health administration value.

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