Liu Zifeng, Yuan Lianxiong, Huang Yixiang, Zhang Lingling, Luo Futian
Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China School of Public Health, Sun Yat-sen University, Guangzhou, China.
School of Public Health, Sun Yat-sen University, Guangzhou, China.
BMJ Open. 2016 Feb 24;6(2):e010504. doi: 10.1136/bmjopen-2015-010504.
We aimed to develop a questionnaire for quantitative evaluation of the autonomy of public hospitals in China.
An extensive literature review was conducted to select possible items for inclusion in the questionnaire, which was then reviewed by 5 experts. After a two-round Delphi method, we distributed the questionnaire to 404 secondary and tertiary hospitals in Guangdong Province, China, and 379 completed questionnaires were collected. The final questionnaire was then developed on the basis of the results of exploratory and confirmatory factor analysis.
Analysis suggested that all internal consistency reliabilities exceeded the minimum reliability standard of 0.70 for the α coefficient. The overall scale coefficient was 0.87, and 6 subscale coefficients were 0.92 (strategic management), 0.81 (budget and expenditure), 0.85 (financing), 0.75 (financing, medical management), 0.86 (human resources) and 0.86 (accountability). Correlation coefficients between and among items and their hypothesised subscales were higher than those with other subscales. The value of average variance extracted (AVE) was higher than 0.5, the value of construct reliability (CR) was higher than 0.7, and the square roots of the AVE of each subscale were larger than the correlation of the specific subscale with the other subscales, supporting the convergent and discriminant validity of the Chinese version of the Hospital Autonomy Questionnaire (CVHAQ). The model fit indices were all acceptable: χ(2)/df=1.73, Goodness of Fit Index (GFI) = 0.93, Adjusted Goodness of Fit Index (AGFI) = 0.91, Non-Normed Fit Index (NNFI) = 0.96, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.04, Standardised Root Mean Square Residual (SRMR) = 0.07.
This study demonstrated the reliability and validity of a CVHAQ and provides a quantitative method for the assessment of hospital autonomy.
我们旨在开发一份用于定量评估中国公立医院自主性的问卷。
进行了广泛的文献综述以选择可能纳入问卷的项目，然后由5位专家进行评审。经过两轮德尔菲法后，我们将问卷分发给中国广东省的404家二级和三级医院，共收集到379份完整问卷。最终问卷是在探索性和验证性因素分析结果的基础上制定的。
分析表明，所有内部一致性信度均超过了α系数0.70的最低信度标准。总体量表系数为0.87，6个分量表系数分别为0.92（战略管理）、0.81（预算与支出）、0.85（融资）、0.75（融资、医疗管理）、0.86（人力资源）和0.86（问责制）。各项目与其假设的分量表之间的相关系数高于与其他分量表的相关系数。平均提取方差（AVE）值高于0.5，建构信度（CR）值高于0.7，且各分量表AVE的平方根大于特定分量表与其他分量表的相关性，支持中文版医院自主性问卷（CVHAQ）的聚合效度和区分效度。模型拟合指数均可接受：χ(2)/df = 1.73，拟合优度指数（GFI）= 0.93，调整后拟合优度指数（AGFI）= 0.91，非规范拟合指数（NNFI）= 0.96，比较拟合指数（CFI）= 0.97，近似均方根误差（RMSEA）= 0.04，标准化均方根残差（SRMR）= 0.07。
本研究证明了CVHAQ的信度和效度，并为医院自主性评估提供了一种定量方法。
