Dolovich Lisa R, Nair Kalpana M, Ciliska Donna K, Lee Hui N, Birch Stephen, Gafni Amiram, Hunt Dereck L
Centre for Evaluation of Medicines, Hamilton, Ontario, Canada.
Health Soc Care Community. 2004 Nov;12(6):475-87. doi: 10.1111/j.1365-2524.2004.00517.x.
The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.
本研究的目的是开发并进行预试验一份问卷，以从糖尿病患者的角度评估医疗连续性。开展了7个患者焦点小组和2个医疗服务提供者焦点小组。这些焦点小组产生了777个潜在条目。经过条目删减、表面效度测试和可读性分析后，条目数量减少到56个，经过初步因子分析后减少到47个。可读性评估结果为需要7至8年的学校教育水平。60名成年糖尿病患者在单一时间点完成了糖尿病医疗连续性量表（DCCS）初稿，以评估该工具的效度。患者在2周后再次完成DCCS初稿，以评估重测信度。根据临床意义进行的临时因子分析和分组产生了五个领域：就诊机会与获得医疗服务、医生提供的护理、其他医疗专业人员提供的护理、医疗专业人员之间的沟通以及自我护理。整个量表的内部一致性（克朗巴哈系数）为0.89。重测信度为r = 0.73。DCCS总分与用于建立结构效度的一些测量指标呈中度相关。DCCS能够区分实现和未实现良好糖尿病护理的特定过程及临床指标（例如在6个月内检测糖化血红蛋白）的患者。DCCS的开发以患者视角为中心，结果显示患者对医疗连续性的看法超出了看同一位医生的概念。该工具的初步测试表明，它有望成为该领域可靠且有效的测量工具。
