Department of Medicine, University of Michigan Health System, Ann Arbor, MI, United States of America.
Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States of America.
PLoS One. 2018 Sep 13;13(9):e0203431. doi: 10.1371/journal.pone.0203431. eCollection 2018.
Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity and mortality. This condition is therefore the focus of quality initiatives, which primarily use audit and feedback to improve performance. However, feedback of quality data inconsistently affects clinician behavior. A hypothesis for this inconsistency is that a lack of comprehension of CLABSI data by decision makers prevents behavior change. In order to rigorously test this hypothesis, a comprehension scale is necessary. Therefore, we sought to develop a scale to assess comprehension of CLABSI quality metric data.
The initial instrument was constructed via an exploratory approach, including literature review and iterative item development. The developed instrument was administered to a sample of clinicians, and each item was scored dichotomously as correct or incorrect. Psychometric evaluation via exploratory factor analyses (using tetrachoric correlations) and Cronbach's alpha were used to assess dimensionality and internal consistency.
97 clinicians responded and were included. Factor analyses yielded a scale with one factor containing four items with an eigenvalue of 2.55 and a Cronbach's alpha of 0.82. The final solution was interpreted as an overall CLABSI "comprehension" scale given its unidimensionality and assessment of each piece of data within the CLABSI feedback report. The cohort had a mean performance on the scale of 49% correct (median = 50%).
We present the first psychometric evaluation of a preliminary scale that assesses clinician comprehension of CLABSI quality metric data. This scale has internal consistency, assesses clinically relevant concepts related to CLABSI comprehension, and is brief, which will assist in response rates. This scale has potential policy relevance as it could aid efforts to make quality metrics more effective in driving practice change.
中心静脉相关血流感染（CLABSI）与显著的发病率和死亡率相关。因此，该病症是质量改进措施的重点，这些措施主要通过审核和反馈来提高绩效。然而，质量数据的反馈并不能始终如一地影响临床医生的行为。这种不一致的一个假设是，决策者对 CLABSI 数据的理解不足，从而阻碍了行为的改变。为了严格检验这一假设，需要一个理解量表。因此，我们试图开发一个评估 CLABSI 质量指标数据理解的量表。
初始工具是通过探索性方法构建的，包括文献回顾和迭代项目开发。开发的工具被应用于一组临床医生样本，每个项目都以正确或错误的二分法进行评分。通过探索性因素分析（使用四次相关）和克朗巴赫α进行心理测量评估，用于评估维度和内部一致性。
97 名临床医生做出了回应并被纳入研究。因素分析产生了一个包含四个项目的单因素量表，特征值为 2.55，克朗巴赫α为 0.82。最终的解决方案被解释为 CLABSI 的“理解”量表，因为它具有单一维度，并且评估了 CLABSI 反馈报告中的每一条数据。该队列在量表上的平均表现为 49%正确（中位数=50%）。
我们提出了第一个对初步量表的心理测量评估，该量表评估了临床医生对 CLABSI 质量指标数据的理解。该量表具有内部一致性，评估了与 CLABSI 理解相关的临床相关概念，且简短，这将有助于提高回复率。该量表具有潜在的政策相关性，因为它可以帮助提高质量指标在推动实践变革方面的效果。
