Zinckernagel Line, Schneekloth Nanna, Zwisler Ann-Dorthe Olsen, Ersbøll Annette Kjær, Rod Morten Hulvej, Jensen Poul Dengsøe, Timm Helle, Holmberg Teresa
The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
The Danish Knowledge Center for Rehabilitation and Palliative Care, Department of Oncology, University Hospital Odense and Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark.
BMJ Open. 2017 Oct 30;7(10):e016234. doi: 10.1136/bmjopen-2017-016234.
Measuring the quality of care as experienced by patients is increasingly recognised as a way of improving healthcare services. However, disease-specific measures that take the patient journey into account are needed. This paper presents the development of such a measure for patients with heart disease and details the psychometric evaluation.
The questionnaire was developed based on a literature review, qualitative interviews and a pilot-test. The psychometric evaluation of the measure was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), Cronbach's alpha coefficient and differential item functioning analysis with data from a population-based survey.
Denmark in 2013-2014.
Nineteen heart patients, four relatives and eight health professionals participated in qualitative interviews in the development phase, and 15 patients participated in the pilot-test. The questionnaire was subsequently sent to a random sample of 5000 heart patients who were diagnosed in 2013.
The comprehensive development phase and pilot-testing contributed to high content validity of the questionnaire. Eligible questionnaire responses were received from 2496 patients. EFA indicated a nine-factor model: communication at the hospital, communication with the general practitioner, information on disease and treatment, information on psychosocial aspects, rehabilitation/support, organisation, medication, involvement of relatives and consideration of comorbidity. CFA confirmed the proposed factor structure (eg, goodness-of-fit index=0.88, adjusted goodness-of-fit index=0.86, root mean square error of approximation=0.05), and Cronbach's alpha coefficient revealed good internal consistency of the factors (range: 0.69-0.93).
The results suggest that this disease-specific patient-reported experience measure is of good quality when measuring the quality of care among heart patients. The inclusion of patients in the development phase contributed to high content validity, and subsequent psychometric evaluation found high construct validity and internal consistency. This measure may be especially relevant when seeking information about which aspects of care require improvement and the impact on health outcomes.
将患者体验到的医疗服务质量作为衡量标准，日益被视为改善医疗服务的一种方式。然而，需要有考虑患者就医过程的特定疾病衡量标准。本文介绍了针对心脏病患者的此类衡量标准的制定，并详细阐述了心理测量学评估。
该问卷基于文献综述、定性访谈和预测试编制而成。利用探索性因素分析（EFA）和验证性因素分析（CFA）、克朗巴哈α系数以及基于人群调查的数据进行差异项目功能分析，对该衡量标准进行心理测量学评估。
2013 - 2014年的丹麦。
19名心脏病患者、4名亲属和8名医疗专业人员参与了开发阶段的定性访谈，15名患者参与了预测试。随后，问卷被发送给2013年确诊的5000名心脏病患者的随机样本。
全面的开发阶段和预测试有助于提高问卷的内容效度。收到了2496名患者符合要求的问卷回复。探索性因素分析表明为九因素模型：医院沟通、与全科医生沟通、疾病与治疗信息、心理社会方面信息、康复/支持、组织、药物治疗、亲属参与以及合并症考量。验证性因素分析证实了所提出的因素结构（例如，拟合优度指数 = 0.88，调整后拟合优度指数 = 0.86，近似均方根误差 = 0.05），克朗巴哈α系数显示各因素具有良好的内部一致性（范围：0.69 - 0.93）。
结果表明，这种特定疾病的患者报告体验衡量标准在测量心脏病患者的医疗服务质量时质量良好。在开发阶段纳入患者有助于提高内容效度，随后的心理测量学评估发现具有较高的结构效度和内部一致性。当寻求有关哪些医疗服务方面需要改进以及对健康结果的影响的信息时，该衡量标准可能特别相关。
