Bobrovitz Niklas, Santana Maria J, Kline Theresa, Kortbeek John, Stelfox Henry T
Nuffield Department of Primary Care Health Sciences, University of Oxford, 2nd Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK,
Qual Life Res. 2015 Aug;24(8):1911-9. doi: 10.1007/s11136-015-0919-5. Epub 2015 Jan 15.
The "Quality of Trauma Care Patient-Reported Experience Measure" is the first measure of patient experiences with overall injury care. The objective of this study was to use cognitive interviews to inform revision of the measure into a parsimonious set of items that function as intended, in preparation for multicenter testing.
Concurrent and retrospective cognitive interviews with injured patients (n = 17) and family members (n = 13) using semi-structured interview guides. Responses were analyzed using thematic analysis.
Six broad themes were identified and guided revisions: (1) participants did not have the information to answer items (n = 9); (2) items were ambiguous or were inconsistently interpreted (n = 13); (3) items did not measure the intended constructs (n = 6); (4) items included assumptions about healthcare processes (n = 4); (5) items measured non-priority aspects of injury care (n = 8); and (6) items were redundant (n = 5). Two issues resulted in key conceptual and content changes: participants' difficulty to evaluate pre-hospital, emergency department, and intensive care unit services due to recall issues and the challenge to evaluate the effectiveness and equity of care. In total, 39 items were deleted, 28 new items developed, and the final instrument included 63 items.
Our results informed changes to item content, format, and response options. This study highlights key issues to consider when incorporating patient/family perspectives into quality measurement, most notably, that few participants can assess the quality of care in the pre-hospital and emergency department phases of care and that novel methods are needed to evaluate the effectiveness and equity of care.
“创伤护理患者报告体验质量测量指标”是首个关于患者对整体损伤护理体验的测量指标。本研究的目的是通过认知访谈为将该指标修订为一组简洁且能按预期发挥作用的条目提供依据，为多中心测试做准备。
使用半结构化访谈指南对受伤患者（n = 17）和家庭成员（n = 13）进行同步和回顾性认知访谈。采用主题分析法对回答进行分析。
确定了六个广泛的主题并指导修订：（1）参与者没有信息来回答条目（n = 9）；（2）条目含糊不清或被不一致地解释（n = 13）；（3）条目未测量预期的结构（n = 6）；（4）条目包含对医疗过程的假设（n = 4）；（5）条目测量了损伤护理的非优先方面（n = 8）；以及（6）条目冗余（n = 5）。两个问题导致了关键的概念和内容变化：由于回忆问题，参与者难以评估院前、急诊科和重症监护病房服务，以及评估护理有效性和公平性的挑战。总共删除了39个条目，开发了28个新条目，最终工具包含63个条目。
我们的结果为条目内容、格式和回答选项的变化提供了依据。本研究突出了将患者/家属观点纳入质量测量时需要考虑的关键问题，最显著的是，很少有参与者能够评估护理院前和急诊科阶段的护理质量，并且需要新的方法来评估护理的有效性和公平性。
