Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Top Stroke Rehabil. 2010 Jul-Aug;17(4):282-93. doi: 10.1310/tsr1704-282.
Even though team care is pivotal to stroke rehabilitation, we have few tools to measure team process. Process measures of team functioning would benefit stroke rehabilitation outcomes and quality improvement (QI).
To improve measures of team process and evaluate their potential for use in rehabilitation research and QI.
We use item response theory (IRT) to analyze and revise selected scales from the Team Functioning Survey administrated to rehabilitation staff (n=365 at 31 VA hospitals) as part of a national clinical trial (NCT00237757). Revised scales were evaluated for reliability (Cronbach's alpha) and validity (correlations, predictions of patient outcomes).
Eight scales (60 items) were selected from the TFS for analyses based on their specificity to rehabilitation and potential utility in process improvement. Factor analyses supported the dropping of 2 scales and the combining of 2 scales. As indicated by the IRT analyses of scale psychometric properties, poor performing scale items were dropped and item response categories modified needed areas for further development were identified. Cronbach's alpha for the resultant best 5 scales was good. Intercorrelations varied among scales but were mostly in the moderate ranges. Two of the scales predicted patient outcomes of mFIM™ gain or discharge disposition.
The analyses resulted in measures of 5 central components of team functioning: physician support, shared leadership, supervisor team support, teamness, and team effectiveness. IRT enables the scales to be refined and strengthened for use in outcome research and QI. The scales are proposed as another step toward understanding and enhancing team process.
尽管团队护理对中风康复至关重要，但我们几乎没有工具来衡量团队流程。团队功能的流程衡量标准将有利于中风康复结果和质量改进（QI）。
改进团队流程的衡量标准，并评估其在康复研究和 QI 中的潜在用途。
我们使用项目反应理论（IRT）来分析和修改在国家临床试验（NCT00237757）中向康复人员（31 家 VA 医院的 365 名）管理的团队功能调查（Team Functioning Survey）中选择的量表。修订后的量表评估了可靠性（Cronbach's alpha）和有效性（相关性、患者结果的预测）。
根据 TFS 对康复的特异性和在流程改进中的潜在效用，从 TFS 中选择了 8 个量表（60 个项目）进行分析。因子分析支持删除 2 个量表和合并 2 个量表。根据量表心理测量特性的 IRT 分析，删除了表现不佳的量表项目，并确定了需要进一步开发的项目反应类别。最终的 5 个最佳量表的 Cronbach's alpha 良好。量表之间的相关性不同，但大多处于中等范围。其中 2 个量表预测了 mFIM™增益或出院处置的患者结果。
分析结果得出了团队功能的 5 个核心组成部分的衡量标准：医生支持、共同领导、主管团队支持、团队意识和团队效率。IRT 使量表能够在结果研究和 QI 中得到改进和加强。这些量表被提议作为理解和增强团队流程的又一步。
