Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine-University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Serv Res. 2022 Aug;57(4):806-819. doi: 10.1111/1475-6773.13949. Epub 2022 Feb 18.
To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care.
Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing.
We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity.
Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316).
Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11).
The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.
开发并检验一种基于医院围产期护理的以患者为中心的护理（PCC）文化测量工具。
数据来自美国围产期医院：一家提供了调查开发数据，14 家提供了调查测试数据。
我们使用定性和定量方法开发了母婴为中心的护理（MICC）文化调查。定性方法包括观察、焦点小组、访谈和专家咨询，以适应其他环境中的项目，并创建新的项目，以捕捉英联邦基金会提出的 PCC 的各个方面。我们使用可靠性（Cronbach's α 和 Pearson 相关系数）和有效性（探索性和验证性因素分析[CFA]）统计数据来定量评估调查的心理测量特性，并对调查进行了改进。在确认聚合适用性（ICC）后，我们计算了个体、单位和医院层面的“MICC 文化评分”，并评估了评分与调查收集的员工报告结果之间的关联，以评估同时有效性。
调查开发包括 12 次现场观察、一次半结构化焦点小组（5 名参与者）、两次半结构化访谈、五次认知访谈和三次专家咨询。调查测试使用在线调查，对产科和新生儿单位的工作人员（n=316）进行了调查。
在 10 家至少有两个单位各有≥4 个回应的医院中使用（n=240），20 项 MICC 文化调查显示具有可靠性（Cronbach's α=0.95），同时涵盖了所有 PCC 维度（分量表 Cronbach's α=0.72-0.87）。CFA 通过良好的拟合度证明了有效性（整体卡方=214 [p 值=0.012]，SRMR=0.056，RMSEA=0.041，CFI=0.97，TLI=0.96）。聚合统计数据（ICC<0.05）证明了单位和医院层面的聚合是合理的。初步证明了有效性，个体、单位和医院层面的 MICC 文化评分与所有结果（对提供的护理的满意度、单位内团队的有效性以及单位之间的关系协调[RC]）相关（p 值<0.05），除了新生儿单位评分和 RC（p 值=0.11）。
MICC 文化调查是一种基于医院围产期护理的 PCC 文化的心理测量良好的测量工具。调查评分与员工报告的结果相关。未来对患者结果的研究将有助于确定围产期护理的改进机会。
