Аңдатпа
Aim: Healthcare quality management requires robust, evidence-based evaluation of organizational frameworks. Building on prior findings regarding healthcare professionals' perspectives, this study aimed to evaluate quality management frameworks by examining three-year trends (2023-2025) in patient-reported experience measures (PREMs) across Joint Commission International JCI accredited and nationally accredited institutions within Kazakhstan's day surgery sector. Methods: A repeated cross-sectional, comparative study was conducted among 600 patients in Astana (n=100 per cohort per year). A validated 19-item questionnaire assessed clinical trust, digital maturity, and financial transparency. Statistical analysis employed Pearson's Chi-square tests for gap analysis, Binary Logistic Regression to determine independent predictors of institutional loyalty (Odds Ratios), and Multivariate Cluster Analysis (PCA-style) to map quality zones. Results: Over the three years, a trend of narrowing quality gaps was identified. JCI-accredited institutions were associated with higher ratings in perceived physician competence and digital maturity (56.0% online booking). High physician competence emerged as the primary predictor of loyalty (OR = 4.12; 95% CI: 2.80-6.10, p<0.001), indicating that patients perceiving high competence were four times more likely to recommend the facility. In nationally accredited polyclinics, loyalty ratings increased from 51.0% in 2023 to 74.0% in 2025 (p<0.001). However, in high-tier centers, a significant association was found between high out-of-pocket diagnostic costs (90.0%) and negative perceptions of financial transparency (45.0% in 2025). Conclusion: JCI accreditation is associated with clinical and digital excellence, while national standards correlate with improvements in the service baseline of primary care. The study suggests that sustainable modernization requires management frameworks that balance clinical protocols with infrastructure scalability and transparent financial counseling to maintain institutional integrity.