National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
J Gen Intern Med. 2021 Dec;36(12):3680-3688. doi: 10.1007/s11606-021-06703-x. Epub 2021 Mar 29.
Patient care ownership improves accountability, clinical skills, and quality of patient care among resident physicians, but appears to be gradually eroding. Research is limited by the lack of a reliable, objective measure of ownership.
To validate the Patient Care Ownership Scale, an instrument that measures decision ownership among internal medicine residents.
Multi-institutional, cross-sectional study using a 66-item, online survey that queried residents on ownership's key constructs (advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, self-efficacy, and perceived ownership) as well as mood and burnout.
Internal medicine residents in five geographically diverse residency programs completing an inpatient rotation.
We performed exploratory and confirmatory factor analysis in two randomly split groups to evaluate for subscales and inform item reduction. We conducted reliability testing with Cronbach's α. We performed bivariate analyses to examine construct validity and identify correlates of ownership.
Of the 785 eligible residents, 625 completed the survey (80% response rate); we included responses from 563 in the analysis. We identified three factors corresponding to assertiveness, conscientiousness, and confidence or perceived competence. After iterative item reduction, the 13-item ownership scale demonstrated good reliability (Cronbach's α = 0.82). Convergent validity was supported by a significant association with perceived ownership (eliminated from the final scale) (r = 0.67, p < 0.001). There was a positive association between ownership and training level (p < 0.01) and prior experience in the intensive care unit (p < 0.001). There were significant, inverse relationships between ownership and self-defined burnout (r = - 0.24, p < 0.001), depression (r = - 0.22, p < 0.001), detachment (r = - 0.26, p < 0.001), and frustration (r = - 0.15, p = 0.02), and significant positive associations between ownership and feeling energetic (r = 0.29, p < 0.001), happy (r = 0.33, p < 0.001), and fulfilled (r = 0.34, p < 0.001).
The Patient Care Ownership Scale is valid in diverse residency program settings. Medical educators and investigators can use our scale to assess interventions aimed at fostering ownership.
患者护理所有权可提高住院医师的责任感、临床技能和患者护理质量，但这种情况似乎正在逐渐消失。由于缺乏可靠、客观的所有权衡量标准，相关研究受到限制。
验证患者护理所有权量表，这是一种衡量内科住院医师决策所有权的工具。
采用多机构、横断面研究设计，使用包含 66 个项目的在线调查，调查对象为住院医师的所有权关键结构（倡导、责任、问责制、跟进、知识、沟通、主动性、护理连续性、自主性、自我效能感和感知所有权）以及情绪和倦怠。
在五个地理位置不同的住院医师培训项目中完成住院实习的内科住院医师。
我们在两组随机分割的小组中进行探索性和验证性因素分析，以评估亚量表并告知项目减少。我们使用克朗巴赫 α 进行可靠性测试。我们进行了双变量分析，以检验结构有效性并确定所有权的相关性。
在 785 名符合条件的住院医师中，有 625 名完成了调查（80%的回复率）；我们将 563 名的回复纳入分析。我们确定了三个与自信、尽责和信心或感知能力相对应的因素。经过迭代项目缩减，13 项所有权量表显示出良好的可靠性（克朗巴赫 α=0.82）。与感知所有权（已从最终量表中删除）的显著相关性支持了收敛效度（r=0.67，p<0.001）。所有权与培训水平（p<0.01）和重症监护病房的先前经验（p<0.001）呈正相关。所有权与自我定义的倦怠（r=-0.24，p<0.001）、抑郁（r=-0.22，p<0.001）、疏离（r=-0.26，p<0.001）和挫折（r=-0.15，p=0.02）呈显著负相关，与精力充沛（r=0.29，p<0.001）、快乐（r=0.33，p<0.001）和满足感（r=0.34，p<0.001）呈显著正相关。
患者护理所有权量表在不同住院医师培训项目环境中具有有效性。医学教育者和研究人员可以使用我们的量表评估旨在培养所有权的干预措施。
