Hu Guangyu, Yuan Changzheng, Ren Haoming, Hu Jinliang, Shang Mingxia, Wang Kun
Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
School of Public Health, Zhejiang University, Hangzhou, China.
Transl Pediatr. 2021 Sep;10(9):2269-2280. doi: 10.21037/tp-21-130.
The Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) is a standard instrument to measure pediatric inpatients' experience of care. Currently, no Chinese version of the Child HCAHPS exists for Chinese patients. Therefore, this study aimed to create a Chinese version of the Child HCAHPS and investigate its validity and reliability in a Chinese setting.
Using the approach recommended in guidelines from the Agency for Healthcare Research and Quality for translating HCAHPS surveys, we produced a Chinese version of the Child HCAHPS. A two-month field test with seven hospitals across five provinces in China was performed to assess its validity. Construct validity was assessed using confirmatory factor analysis. We evaluated convergent validity by factor loading, average variance extracted (AVE), and construct reliability (CR). Cronbach's alpha and corrected item-total correlation (CITC) were used to reflect hospital-level unit reliabilities for the survey's item composites. The correlation of the measure score with the overall rating was calculated to evaluate criterion validity.
An overall response rate of 63% was achieved, and 2,258 respondents completed the questionnaire. Confirmatory factor analysis showed a comparative fit index (CFI) of 0.905, a non-normed fix index of 0.886, and a root mean square error of approximation (RMSEA) of 0.089. Most items had factor loadings over 0.7. Cronbach's alpha coefficient on the overall level was 0.981, and all measures' CITC exceeded 0.6, demonstrating good to excellent hospital-level reliability of the composite and single-item measures. All composite measures had good to excellent internal consistency reliability (0.716 to 0.994). Item-to-composite correlation ranged from 0.510 to 0.997. Composite-to-composite correlations ranged from 0.488 to 0.997. According to the survey result, for all the 18 composite or single-item measures, mean top-box scores ranged from 56% ("Involving teens in care") to 87% ("Informed in Emergency Room").
The Chinese version of the Child HCAHPS demonstrated acceptable validity and reliability. The application of this tool can help benchmark ongoing healthcare improvement initiatives in China.
儿童医院医疗服务提供者及系统消费者评估（Child HCAHPS）是衡量儿科住院患者护理体验的标准工具。目前，尚无适用于中国患者的中文版Child HCAHPS。因此，本研究旨在创建中文版Child HCAHPS，并在中国背景下调查其有效性和可靠性。
采用医疗保健研究与质量局（Agency for Healthcare Research and Quality）翻译HCAHPS调查问卷指南中推荐的方法，我们制作了中文版Child HCAHPS。在中国五个省份的七家医院进行了为期两个月的现场测试，以评估其有效性。使用验证性因素分析评估结构效度。我们通过因素负荷、平均提取方差（AVE）和结构可靠性（CR）来评估收敛效度。使用Cronbach's alpha和校正的项目-总分相关性（CITC）来反映调查项目组合的医院层面单位可靠性。计算测量分数与总体评分的相关性以评估准则效度。
总体回复率达到63%，2258名受访者完成了问卷。验证性因素分析显示，比较拟合指数（CFI）为0.905，非标准化拟合指数为0.886，近似均方根误差（RMSEA）为0.089。大多数项目的因素负荷超过0.7。总体水平的Cronbach's alpha系数为0.981，所有测量的CITC均超过0.6，表明综合和单项测量在医院层面具有良好至优秀的可靠性。所有综合测量均具有良好至优秀的内部一致性可靠性（0.716至0.994）。项目与综合的相关性范围为0.510至0.997。综合与综合的相关性范围为0.488至0.997。根据调查结果，对于所有18项综合或单项测量，最高等级分数的平均值范围从56%（“让青少年参与护理”）到87%（“在急诊室得到通知”）。
中文版Child HCAHPS显示出可接受的有效性和可靠性。该工具的应用有助于为中国正在进行的医疗保健改进举措设定基准。
