Chen Chi-Chen, Chiang Yi-Chen, Lin Yi-Chieh, Cheng Shou-Hsia
Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
School of Public Health, Xiamen University, Xiamen, China.
Int J Integr Care. 2023 Feb 17;23(1):10. doi: 10.5334/ijic.6467. eCollection 2023 Jan-Mar.
Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective.
Face-to-face interviews were conducted nationwide with community-dwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%.
The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified.
The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective.
医疗连续性和协调性均被视为医疗保健系统的基本要素。然而，对于医疗连续性与协调性之间的关系，人们知之甚少。本研究旨在通过开发并测试“联合门诊医疗连续性与协调性评估问卷（COCCCA）”的信效度，从患者角度区分医疗连续性与协调性的概念，该问卷适用于台湾全民健康保险制度下的门诊医疗。
通过分层多阶段系统抽样法，按规模大小成比例的概率抽样，在全国范围内对社区居住的老年人进行面对面访谈。共有2144名受试者完成问卷，应答率为44.67%。
通过项目分析和主成分分析（PCA）确定了COCCCA问卷的16个项目。主成分分析产生了五个维度：三个以连续性为导向（患者与医生之间的人际、信息共享和纵向连续性）和两个以协调性为导向（多位医生之间的信息交流和沟通/合作）。二阶验证性因素分析支持该因素结构，并表明可以识别出医疗连续性和协调性的不同结构。
COCCCA工具能够区分医疗连续性和医疗协调性的概念，并且已从患者角度证明在门诊医疗环境中具有有效性和可靠性。
