实践促进者关键驱动因素实施量表（KDIS）：“东南合作改善血压控制”试验中的心理计量学测试。

The Key Driver Implementation Scale (KDIS) for practice facilitators: Psychometric testing in the "Southeastern collaboration to improve blood pressure control" trial.

机构信息

Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.

Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America.

出版信息

PLoS One. 2022 Aug 24;17(8):e0272816. doi: 10.1371/journal.pone.0272816. eCollection 2022.

DOI:10.1371/journal.pone.0272816

PMID:36001592

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9401114/

Abstract

BACKGROUND

Practice facilitators (PFs) provide tailored support to primary care practices to improve the quality of care delivery. Often used by PFs, the "Key Driver Implementation Scale" (KDIS) measures the degree to which a practice implements quality improvement activities from the Chronic Care Model, but the scale's psychometric properties have not been investigated. We examined construct validity, reliability, floor and ceiling effects, and a longitudinal trend test of the KDIS items in the Southeastern Collaboration to Improve Blood Pressure Control trial.

METHODS

The KDIS items assess a practice's progress toward implementing: a clinical information system (using their own data to drive change); standardized care processes; optimized team care; patient self-management support; and leadership support. We assessed construct validity and estimated reliability with a multilevel confirmatory factor analysis (CFA). A trend test examined whether the KDIS items increased over time and estimated the expected number of months needed to move a practice to the highest response options.

RESULTS

PFs completed monthly KDIS ratings over 12 months for 32 primary care practices, yielding a total of 384 observations. Data was fitted to a unidimensional CFA model; however, parameter fit was modest and could be improved. Reliability was 0.70. Practices started scoring at the highest levels beginning in month 5, indicating low variability. The KDIS items did show an upward trend over 12 months (all p < .001), indicating that practices were increasingly implementing key activities. The expected time to move a practice to the highest response category was 9.1 months for standardized care processes, 10.2 for clinical information system, 12.6 for self-management support, 13.1 for leadership, and 14.3 months for optimized team care.

CONCLUSIONS

The KDIS items showed acceptable reliability, but work is needed in larger sample sizes to determine if two or more groups of implementation activities are being measured rather than one.

摘要

背景

实践促进者 (PF) 为基层医疗实践提供定制支持，以提高护理服务质量。PF 经常使用“关键驱动因素实施量表” (KDIS) 来衡量实践实施慢性病护理模型中质量改进活动的程度，但该量表的心理测量特性尚未得到研究。我们在东南协作改善血压控制试验中检验了 KDIS 条目的构念效度、信度、地板和天花板效应以及纵向趋势测试。

方法

KDIS 条目的评估实践在以下方面的进展：临床信息系统（使用自己的数据来推动变革）；标准化护理流程；优化团队护理；患者自我管理支持；以及领导力支持。我们采用多层次验证性因素分析 (CFA) 评估构念效度并估计信度。趋势测试检验了 KDIS 条目是否随时间增加，并估计了将实践转移到最高响应选项所需的预期月数。

结果

PF 在 12 个月内每月完成 32 个基层医疗实践的 KDIS 评分，共产生 384 个观测值。数据拟合到一个单维 CFA 模型；然而，参数拟合适中，可以改进。信度为 0.70。实践从第 5 个月开始就开始获得最高评分，表明可变性低。KDIS 条目在 12 个月内呈上升趋势（所有 p <.001），表明实践越来越多地实施关键活动。将实践转移到最高响应类别的预期时间为标准化护理流程 9.1 个月，临床信息系统 10.2 个月，自我管理支持 12.6 个月，领导力 13.1 个月，优化团队护理 14.3 个月。