非医院医疗保健中心提供基本急救护理的准备情况评估工具包：一项序贯探索性混合方法研究。

Non-hospital healthcare center's preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study.

机构信息

Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran.

Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Side to Shahran Tower, Golshahr Square, Eil Goli Street, Tabriz, East Azerbaijan, Iran.

出版信息

BMC Health Serv Res. 2023 Jan 23;23(1):70. doi: 10.1186/s12913-023-09053-y.

DOI:10.1186/s12913-023-09053-y

PMID:36690961

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9872316/

Abstract

BACKGROUND

Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs' preparedness to provide initial emergency care.

METHODS

This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach's alpha, Intra-class Correlation Coefficient, and Kendal's Tau-b. All the statistical analyses were performed using Stata 14.

RESULTS

In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: "Environmental Infrastructures of Centers", "Protocols, Guidelines and Policies", "Medical Supplies and Equipment", "Emergency Medicines", "Human Resources", "Clinical Interventions", "Maintenance of equipment", "Medicine Storage Capability", and "Management Process". The toolbar had acceptable validity and reliability.

CONCLUSIONS

This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.

摘要

背景

城乡基本应急管理是一个关键挑战，会影响院前死亡率。因此，非医院医疗中心（NHHC）必须做好准备，以应对这些中心所在地理区域内可能发生的紧急情况。本研究的主要目的是开发和验证 NHHC 提供初步急救准备情况的工具条。

方法

本研究采用两阶段序贯探索性混合方法设计，每一阶段均有三个步骤。在第一阶段，文献系统评价和定性方法（焦点小组讨论（FGD）和半结构化访谈（SSI））用于确定领域和条目。在第二阶段，对工具条的内容有效性、可行性和可靠性进行了评估。内容有效性采用基于清晰度和相关性标准的改良 Kappa 系数进行评估。工具条的可行性通过在大不里士的 10 个中心随机实施进行评估。在 30 个中心进行的预试验中对可靠性进行了随机评估。通过测量内部一致性、重测信度和评分者间一致性来评估可靠性。评估可靠性的主要统计方法包括 Cronbach's alpha、组内相关系数和 Kendall's Tau-b。所有统计分析均使用 Stata 14 进行。

结果

在第一阶段，生成了包含 134 个与评估 NHHC 准备情况相关的项目的初步工具条。在第二阶段，应用了项目缩减，最终开发出包含 126 个项目的工具条，这些项目分为 9 个领域，包括：“中心环境基础设施”、“协议、指南和政策”、“医疗用品和设备”、“急救药品”、“人力资源”、“临床干预”、“设备维护”、“药品储存能力”和“管理流程”。该工具条具有可接受的有效性和可靠性。