Sanabria-Arenas Mauricio, Marín Julia Tobón-, Certuche-Quintana María Claudia, Sánchez-Pedraza Ricardo
Renal Therapy Services (RTS), Bogotá D.C, Colombia.
Edificio City Business, Transversal 23 # 97-73, 6° Piso, Bogotá, Colombia.
BMC Health Serv Res. 2017 May 3;17(1):321. doi: 10.1186/s12913-017-2251-y.
Patients' satisfaction is an indicator of the quality of healthcare services. Its measurement involves developing and validating complex instruments. The purpose of this study was to validate a scale for measuring hemodialysis patients' satisfaction with the provided care, the Scale for Evaluation of Hemodialysis Patient's Satisfaction with Service provided at a Chronic Kidney Disease Unit (or ESUR-HD, its acronym in Spanish).
The instrument was applied to 370 patients undergoing hemodialysis for undertaking exploratory and confirmatory analyses, internal consistency assessment, and Rasch analysis. In order to assure test-retest reliability, the instrument was applied once again to 54 patients after 2 days. Convergent validity was assessed by estimating correlation coefficients based on the results of 2 instruments (ESUR-HD and SDIALOR) simultaneously applied in 70 patients. Sensitivity to change was assessed in 40 patients by comparing the scale scores before and after an intervention consisting of improved care conditions.
In the 44 items of the scale a 9-factor structure was found (1: Facilities and organization of the service. 2: Care provided by the attending nurses and/or nursing assistants. 3: Attention to psychological and administrative issues. 4: Contact and social work personnel. 5: Medical attention and care. 6: Nutritional attention and care. 7: Medications supply and quality. 8: Features of the admission process. 9: Attention and care provided by head nurses). Chronbach alpha for the scale was 0.96. Lin's concordance correlation for the whole scale was 0.85. Although statistically different from 0, low correlation values with dimensions from another scale measuring the same attribute were found. The scale could detect construct changes through increased scores in specific dimensions following an intervention aimed at enhancing satisfaction. Rasch analysis located improperly fit items and suggested reducing items measurement levels. Despite the effect encountered, Rasch analysis showed the scale might not capture variability in upper attribute levels.
The ESUR-HD scale measures hemodialysis patients' satisfaction in one dimension with 9 domains. Validity and reliability are adequate. The instrument may detect changes in the construct. Subsequent versions of the scale should include new items allowing improved discrimination amongst high satisfaction levels.
ISRCTN45318400 . April 05, 2017.
患者满意度是医疗服务质量的一个指标。其测量涉及开发和验证复杂的工具。本研究的目的是验证一个用于测量血液透析患者对所提供护理满意度的量表，即慢性肾脏病单元血液透析患者服务满意度评估量表（或ESUR-HD，其西班牙语首字母缩写）。
该工具应用于370例接受血液透析的患者，进行探索性和验证性分析、内部一致性评估以及拉施分析。为确保重测信度，2天后再次对54例患者应用该工具。通过基于同时应用于70例患者的2种工具（ESUR-HD和SDIALOR）的结果估计相关系数来评估收敛效度。通过比较由改善护理条件组成的干预前后的量表得分，对40例患者评估变化敏感性。
在该量表的44个项目中发现了一个9因素结构（1：服务的设施和组织。2：主治护士和/或护理助理提供的护理。3：对心理和管理问题的关注。4：联络和社会工作人员。5：医疗护理。6：营养护理。7：药物供应和质量。8：入院流程的特点。9：护士长提供的护理）。该量表的克朗巴赫α系数为0.96。整个量表的林一致性相关系数为0.85。尽管与0有统计学差异，但发现与另一个测量相同属性的量表维度的相关值较低。该量表可以通过旨在提高满意度的干预后特定维度得分的增加来检测结构变化。拉施分析定位了拟合不当的项目，并建议降低项目测量水平。尽管遇到了这种影响，但拉施分析表明该量表可能无法捕捉较高属性水平的变异性。
ESUR-HD量表在一个维度上用9个领域测量血液透析患者的满意度。效度和信度足够。该工具可以检测结构变化。该量表的后续版本应包括新的项目，以改善在高满意度水平之间的区分。
ISRCTN45318400。2017年4月5日。
