Wilson A, Hewitt G, Matthews R, Richards S H, Shepperd S
Department of Health Sciences, University of Leicester, Leicester, UK.
Qual Saf Health Care. 2006 Oct;15(5):314-9. doi: 10.1136/qshc.2005.016642.
Individual trials have suggested high levels of general patient satisfaction with intermediate care, but this topic has not been examined in detail.
To identify the key elements of patient satisfaction with intermediate care, and to see whether these can be validly measured using a questionnaire.
A questionnaire was developed on the basis of a literature review and piloting with patients and staff on participating schemes (phase I). In phase II, the questionnaire was tested for validity and reliability in a group of patients recently discharged from two "hospital-at-home" intermediate-care schemes. In phase III, a shortened version of the questionnaire was psychometrically tested in five sites taking part in a national evaluation of intermediate care.
96 patients with an average age of 76.5 years took part in phase II. Test-retest reliability was evaluated by repeating the questionnaire 2 weeks later in a subsample of 42 patients. This was "moderate" (kappa 0.4-0.6) for 12 questions, "fair" (kappa 0.2-0.4) for 6 questions and "poor" (kappa 0.1-0.2) for 5 questions. Scores correlated well with the Client Satisfaction Questionnaire (Spearman's r = 0.75, p<0.001). 843 patients (57% of those eligible) from five intermediate-care schemes took part in phase III. Principal components analysis suggested six factors or subscales: general satisfaction, affective response, cognitive response, timing of discharge, coordination after discharge, and access to pain relief, although the last three factors comprised only one question each. The intraclass correlation coefficients in the first three subscales varied from 0.82 to 0.89. Scores for all subscales differed by scheme, suggesting construct validity. Only one question (on general satisfaction) was found to be redundant.
The questionnaire, with some minor amendments to improve performance, could be used as a validated tool for audit and research in intermediate care. An amended version and scoring programme is available from us on request.
个别试验表明患者对过渡性护理总体满意度较高，但该主题尚未得到详细研究。
确定患者对过渡性护理满意度的关键要素，并探讨能否通过问卷对这些要素进行有效测量。
在文献综述以及对参与项目的患者和工作人员进行预试验的基础上（第一阶段）编制问卷。在第二阶段，对两组近期从“居家医院”过渡性护理项目出院的患者进行问卷效度和信度测试。在第三阶段，对参与全国过渡性护理评估的五个机构中的问卷简版进行心理测量学测试。
96名平均年龄为76.5岁的患者参与了第二阶段研究。通过在42名患者的子样本中于两周后重复进行问卷调查来评估重测信度。12个问题的重测信度为“中等”（kappa值0.4 - 0.6），6个问题为“尚可”（kappa值0.2 - 0.4），5个问题为“较差”（kappa值0.1 - 0.2）。得分与患者满意度问卷相关性良好（斯皮尔曼相关系数r = 0.75，p<0.001）。来自五个过渡性护理项目的843名患者（占符合条件者的57%）参与了第三阶段研究。主成分分析提出了六个因素或子量表：总体满意度、情感反应、认知反应、出院时间、出院后协调以及疼痛缓解的可及性，不过最后三个因素各仅包含一个问题。前三个子量表的组内相关系数在0.82至0.89之间。所有子量表的得分因项目而异，表明具有结构效度。仅发现一个问题（关于总体满意度）多余。
该问卷经一些小的修改以提高性能后，可作为过渡性护理审核和研究的有效工具。如有需要，我们可提供修订版及计分程序。
