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09.11.2017 | Original Article | Ausgabe 2/2018

Journal of Public Health 2/2018

Trace and evaluation systems for health services quality in rural and remote areas: a systematic review

Journal of Public Health > Ausgabe 2/2018
Xiuxia Li, Lili Wei, Wenru Shang, Xin Xing, Min Yin, Juan Ling, Kuoray Mao, Yiliang Zhu, Kehu Yang
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10389-017-0858-4) contains supplementary material, which is available to authorized users.
The original version of this article was revised: Due to the existence of another journal with the same name, the Publisher has added a subtitle, “From Theory to Practice.” Effective as of January 2018, the new title of this Journal is Journal of Public Health: From Theory to Practice.
Xiuxia Li and Lili Wei are joint first authors
A correction to this article is available online at https://​doi.​org/​10.​1007/​s10389-017-0893-1.



To provide a systematic review of the existing theory, framework, systems and instruments for tracing and evaluating quality in rural health services.

Subjects and methods

We searched six electronic databases up to March 2016. Observational studies of quality assessment of rural health services using theoretical models were included. Ekman’s scale was used to evaluate the quality of the included studies.


A total of 18 studies, published between 2001 and 2015, met the inclusion criteria. The corresponding authors for most of them (7, 44%) are from Chinese institutions and three (3, 17%) from Australian institutions. Five studies (28%) focused on township hospitals. Primary health care quality was reported in five studies (28%), followed by clinical service in four (22%). More than half of the studies (61%) were considered of high quality, and the remainder was of moderate quality. These studies applied 16 theoretical systems, including the model/pattern (4, 25%), method/tool (7, 44%) and framework of the theory (5, 31%). Most of the theoretical models (14, 88%) obtained positive observations. In addition, the conceptual model (6, 36%) and TOPSIS method (2, 13%) were more frequently reported.


Although most of the current studies were considered to have high-quality and positive results, there were limitations in the number of publications and research on theoretical systems. The lacks of unified standards and comprehensive evaluation are important issues that need to be pointed out and resolved.

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