Weeks Douglas L, Polello Jennifer M, Hansen Daniel T, Keeney Benjamin J, Conrad Douglas A
Inland Northwest Health Services, 601 W. First Ave., Spokane, WA, 99201, USA,
J Gen Intern Med. 2014 Jan;29(1):98-103. doi: 10.1007/s11606-013-2566-2. Epub 2013 Jul 30.
Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific instruments to systematically assess readiness and/or status of primary care clinics to engage in diabetes care coordination.
This report describes the development and initial validation of the Diabetes Care Coordination Readiness Assessment (DCCRA), which is intended to measure primary care clinic readiness to coordinate care for adult patients with diabetes.
The instrument was developed through iterative item generation within a framework of five domains of care coordination: Organizational Capacity, Care Coordination, Clinical Management, Quality Improvement, and Technical Infrastructure.
Validation data was collected on 39 primary care clinics.
Content validity, inter-rater reliability, internal consistency, and construct validity of the 49-item instrument were assessed.
Inter-rater agreement indices per item ranged from 0.50 to 1.0. Cronbach's alpha of the entire instrument was 0.964, and for the five domain scales ranged from 0.688 to 0.961. Clinics with existing care coordinators were rated as more ready to support care coordination than clinics without care coordinators for the entire DCCRA and for each domain, supporting construct validity.
As providers increasingly attempt to adopt patient-centered approaches, introduction of the DCCRA is timely and appropriate for assisting clinics with identifying gaps in provision of care coordination services. The DCCRA's strengths include promising psychometric properties. A valid measure of diabetes care coordination readiness should be useful in diabetes program evaluation, assistance with quality improvement initiatives, and measurement of patient-centered care in research.
并非所有基层医疗诊所都准备好为糖尿病等慢性病实施护理协调服务。了解真正的护理协调能力是建立有效且高效的护理协调的重要第一步。然而，我们未能找到专门用于系统评估基层医疗诊所参与糖尿病护理协调的准备情况和/或现状的工具。
本报告描述了糖尿病护理协调准备情况评估工具（DCCRA）的开发及初步验证过程，该工具旨在衡量基层医疗诊所为成年糖尿病患者协调护理的准备情况。
该工具是在护理协调的五个领域框架内通过迭代项目生成而开发的，这五个领域包括：组织能力、护理协调、临床管理、质量改进和技术基础设施。
收集了39家基层医疗诊所的验证数据。
评估了该49项工具的内容效度、评分者间信度、内部一致性和结构效度。
各项目的评分者间一致性指数范围为0.50至1.0。整个工具的Cronbach's alpha系数为0.964，五个领域量表的系数范围为0.688至0.961。对于整个DCCRA及其每个领域，有现有护理协调员的诊所被评为比没有护理协调员的诊所更有准备支持护理协调，这支持了结构效度。
随着医疗服务提供者越来越多地尝试采用以患者为中心的方法，引入DCCRA对于协助诊所识别护理协调服务提供中的差距来说既及时又合适。DCCRA的优势包括良好的心理测量特性。一个有效的糖尿病护理协调准备情况测量工具应有助于糖尿病项目评估、协助质量改进计划以及在研究中衡量以患者为中心的护理。
