Psychology and Methods, Jacobs University Bremen, Campus Ring 1, Bremen 28759, Germany.
German Coalition for Patient Safety (Aktionsbuendnis Patientensicherheit e.V.), Alte Jakobsstraße 81, Berlin 10179, Germany.
Int J Qual Health Care. 2021 Apr 16;33(2). doi: 10.1093/intqhc/mzab063.
Patient-centered care and patient involvement have been increasingly recognized as crucial elements of patient safety. However, patient safety has rarely been evaluated from the patient perspective with a quantitative approach aiming at making patient safety and preventable adverse events measurable.
The objectives of this study were to develop and evaluate the psychometric properties of a questionnaire assessing patient safety by perceived triggers of preventable adverse events among patients in primary health-care settings while considering mental health.
Two hundred and ten participants were recruited through various digital and print channels and asked to complete an online survey between November 2019 and April 2020. Exploratory factor analysis was performed to identify domains of triggers of preventable adverse events affecting patient safety. Furthermore, a multi-trait scaling analysis was performed to evaluate internal reliability as well as item-scale convergent-discriminant validity. A multivariate analysis of covariance evaluated whether individuals below and above the symptom threshold for depression and generalized anxiety perceive triggers of preventable adverse events differently.
The five factors determined were information and communication with patients, time constraints of health-care professionals, diagnosis and treatment, hygiene and communication among health-care professionals, and knowledge and operational procedures. The questionnaire demonstrated a good total and subscale internal consistency (α = 0.90, range = 0.75-0.88), good item-scale convergent validity with significant correlations between 0.57 and 0.78 (P < 0.05; P < 0.01) for all items with their associated subscales, and satisfactory item-scale discriminant validity between 0.14 and 0.55 (P > 0.05) with no significant correlations between the items and their competing subscales. The questionnaire further revealed to be a generic measure irrespective of patients' mental health status. Patients older than 50 years of age perceived a significantly greater threat to their own safety compared to patients below that age.
The developed Perceptions of Preventable Adverse Events Assessment Tool (PPAEAT) exhibits good psychometric properties, which supports its use in future research and primary health-care practice. Further validation of the PPAEAT in different settings, languages and larger samples is needed. The results of this study need to be considered when assessing patient safety in the context of health-care research.
以患者为中心的护理和患者参与已被越来越多地视为患者安全的关键要素。然而，很少有从患者角度出发，采用旨在使患者安全和可预防不良事件可衡量的定量方法来评估患者安全。
本研究的目的是开发和评估一种评估工具，该工具通过考虑心理健康，从初级保健环境中患者的角度出发，评估患者对可预防不良事件触发因素的感知，从而评估患者安全。
210 名参与者通过各种数字和印刷渠道招募，并要求他们在 2019 年 11 月至 2020 年 4 月期间完成在线调查。进行探索性因素分析以确定影响患者安全的可预防不良事件触发因素的领域。此外，还进行了多特质评分分析，以评估内部可靠性以及项目-量表的收敛-区分效度。使用多元协方差分析评估抑郁和广泛性焦虑症状阈值以下和以上的个体对可预防不良事件触发因素的感知是否不同。
确定的五个因素是与患者的信息和沟通、医疗保健专业人员的时间限制、诊断和治疗、卫生保健人员之间的沟通以及知识和操作程序。问卷表现出良好的总评分和子量表内部一致性（α=0.90，范围为 0.75-0.88），与所有项目相关的子量表之间的显著相关性为 0.57 至 0.78（P<0.05；P<0.01），具有良好的项目-量表收敛有效性，与所有项目相关的子量表之间的显著相关性为 0.14 至 0.55（P>0.05），项目与其竞争子量表之间没有显著相关性，具有良好的项目-量表区分有效性。该问卷进一步显示为一种通用的衡量标准，与患者的心理健康状况无关。50 岁以上的患者感知到对自身安全的威胁明显大于 50 岁以下的患者。
开发的可预防不良事件感知评估工具（PPAEAT）具有良好的心理测量学特性，支持其在未来的研究和初级保健实践中使用。需要在不同的环境、语言和更大的样本中进一步验证 PPAEAT。在评估医疗保健研究背景下的患者安全时，需要考虑本研究的结果。
