患者照护所有权量表：一种用于测量内科住院医师患者照护所有权的工具的开发。
The Patient Care Ownership Scale: Development of an Instrument to Measure Patient Care Ownership Among Internal Medicine Trainees.
机构信息
National Clinician Scholars Program, Yale University School of Medicine, 333 Cedar Street, Courier SHM IE-66, PO Box 208088, New Haven, CT, 06510, USA.
Veterans Affairs Connecticut Healthcare System, West Haven, CT, 06516, USA.
出版信息
J Gen Intern Med. 2019 Aug;34(8):1530-1537. doi: 10.1007/s11606-019-05066-8. Epub 2019 Jun 3.
BACKGROUND
Patient care ownership is essential to delivering high-quality medical care but appears to be eroding among trainees. The lack of an objective measure has limited the study of ownership in physicians.
OBJECTIVE
To develop an instrument to measure psychological ownership of patient care.
DESIGN
Cross-sectional study.
PARTICIPANTS
Internal medicine trainees in a large, academic hospital completing an inpatient rotation.
MAIN MEASURES
Our scale prototype adapted an existing ownership scale (developed in the non-medical setting) based on themes identified in qualitative studies of patient care ownership. We conducted cognitive interviews to determine face validity of the scale items. Our finalized scale measures ownership's key constructs: advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, and perceived ownership. We distributed an online, anonymous, 46-question survey to 219 residents; 192 residents completed the survey; and 166 responses were included in the analysis. We calculated Cronbach's α to determine the scale's internal consistency. Exploratory factor analysis was used to explore possible subscales. We examined construct validity using bivariate and correlational analysis.
KEY RESULTS
The 15-item ownership scale demonstrated good internal consistency (Cronbach's α = 0.89). We identified three possible subscales corresponding to assertiveness, being the "go-to" person, and diligence. Training level and prior intensive care unit experience significantly predicted ownership (p < 0.01). There was no significant relationship between ownership and age, gender, inpatient service type, call schedule, patient turnover, or supervisory experience of the attending physician. We found a significant negative correlation between ownership and perceived degree of burnout (r = - 0.33), depression (r = - 0.24), detachment (r = - 0.35), and frustration (r = - 0.31) and a significant positive association between ownership and fulfillment (r = 0.37) and happiness (r = 0.36).
CONCLUSION
We developed an instrument to quantify patient care ownership in residents. Our scale demonstrates good internal consistency and preliminary evidence of validity. With further validation, we expect this to be a valuable tool to evaluate interventions aimed at improving ownership.
背景
患者护理的所有权对于提供高质量的医疗保健至关重要，但在受训者中似乎正在逐渐消失。缺乏客观的衡量标准限制了对医生所有权的研究。
目的
开发一种衡量患者护理心理所有权的工具。
设计
横断面研究。
参与者
在一家大型学术医院完成住院轮训的内科受训者。
主要措施
我们的量表原型基于患者护理所有权的定性研究中确定的主题，改编了一个现有的所有权量表（在非医疗环境中开发）。我们进行了认知访谈，以确定量表项目的表面效度。我们最终的量表衡量所有权的关键结构：倡导、责任、问责制、跟进、知识、沟通、主动性、护理连续性、自主性和感知所有权。我们向 219 名住院医师发放了一份在线、匿名的 46 个问题的调查；192 名住院医师完成了调查；166 份答复被纳入分析。我们计算了 Cronbach's α 以确定量表的内部一致性。采用探索性因子分析来探索可能的子量表。我们通过二元和相关性分析来检验结构效度。
主要结果
15 项所有权量表显示出良好的内部一致性（Cronbach's α=0.89）。我们确定了三个可能的子量表，分别对应于自信、成为“首选”和勤奋。培训水平和先前的重症监护病房经验显著预测了所有权（p<0.01）。所有权与年龄、性别、住院服务类型、值班时间表、患者周转率或主治医生的监督经验之间没有显著关系。我们发现所有权与感知的倦怠程度（r=-0.33）、抑郁（r=-0.24）、分离（r=-0.35）和挫折感（r=-0.31）呈显著负相关，与满足感（r=0.37）和幸福感（r=0.36）呈显著正相关。
结论
我们开发了一种用于量化住院医师患者护理所有权的工具。我们的量表显示出良好的内部一致性和初步的有效性证据。随着进一步验证，我们期望这将是评估旨在提高所有权的干预措施的有价值的工具。
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