Lehmann-Mendoza Rodolfo, Cortés-Moreno Gabriela Yanet, Sarabia-González Odet, Figuerola-Escoto Rosa Paola, Luna David, González-Mundo Ilicia, Caselín-Ledezma Rubén, Vázquez-Dávila Roberto Arturo, Martínez-Arredondo Hilario Ascención
Subdirección de Servicios de Salud de Petróleos Mexicanos, Ciudad de México, México.
Coordinación Nacional de Investigación, Petróleos Mexicanos, Ciudad de México, México.
Arch Public Health. 2024 Aug 14;82(1):123. doi: 10.1186/s13690-024-01324-2.
The concept of quality in health care has evolved, placing greater importance on the patient's needs, culture, and social context, as well as their participation in clinical decision-making, as highlighted by Mead and Bower's Person-Centered Care Model. The aim of the present study was to design and validate an instrument to assess the extent to which healthcare services provided by PEMEX (Petróleos Mexicanos) offer person-centered care according to user perceptions.
The first phase comprised the development of 57 items based on the analysis of responses from an open-ended questionnaire administered to 30 users of Pemex healthcare services. This questionnaire was designed considering the four factors of the person-centered care model, however, the high correlation between the 4 factors (i.e., r ≥ .80) indicated an overfactoring effect and consequently an increase in the risk of overfitting. Therefore, an exhaustive analysis of the instrument was performed, starting with the review of the individual behavior of each item, and carrying out exploratory and confirmatory factor analysis. Using a sample of 330 individuals, an exploratory factor analysis was perfomed. Afterward, a confirmatory factorial analysis was carried out with 335 participants. Finally, a new confirmatory factorial analysis included 130 participants due to the refinements made in the previous phase. Internal consistency was assessed using Cronbach's α and McDonald's ω at every phase.
The exploratory factor analysis retained 35 items in a single factor that accounted for 49% of the variance with an internal consistency of Cronbach's α and McDonald's ω = 0.97. Because the factorial structure by confirmatory factorial analysis was unsatisfactory, the initial model was refined, leading to the retention of 11 items and a final model with adjustment index of χ2 = 127.53, χ2/gl = 2.89, RMSEA = 0.07, IC RMSEA 0.06 to 0.09, TLI = 0.95 and CFI = 0.96, with an internal consistency of Cronbach's α and McDonald's ω = 0.93. Due to the refinements, a new confirmatory factorial analysis was conducted with suitable goodness-of-fit criteria in most items (χ2 = 151.44, χ2/gl = 3.43, RMSEA = 0.13, IC RMSEA 0.11 to 0.16, TLI = 0.93 and CFI = 0.94), resulting in a Cronbach's α and McDonald's ω = 0.98.
The instrument exhibits suitable psychometric properties to be employed to measure the degree to which medical care is patient centered. This instrument represents a strategy for promoting an innovative healthcare model.
正如米德和鲍尔的以患者为中心的护理模式所强调的，医疗保健中的质量概念已经演变，更加重视患者的需求、文化和社会背景，以及他们在临床决策中的参与。本研究的目的是设计并验证一种工具，以根据用户认知评估墨西哥国家石油公司（Pemex）提供的医疗服务在多大程度上提供了以患者为中心的护理。
第一阶段包括根据对30名Pemex医疗服务用户进行的开放式问卷调查的回复分析，制定57个项目。该问卷是根据以患者为中心的护理模式的四个因素设计的，然而，这四个因素之间的高相关性（即r≥0.80）表明存在过度因子化效应，从而增加了过度拟合的风险。因此，对该工具进行了详尽分析，首先审查每个项目的个体行为，然后进行探索性和验证性因子分析。使用330名个体的样本进行了探索性因子分析。之后，对335名参与者进行了验证性因子分析。最后，由于在前一阶段进行了改进，对130名参与者进行了新的验证性因子分析。在每个阶段使用克朗巴哈α系数和麦克唐纳ω系数评估内部一致性。
探索性因子分析在一个单一因子中保留了35个项目，该因子解释了49%的方差，克朗巴哈α系数和麦克唐纳ω系数的内部一致性为0.97。由于验证性因子分析的因子结构不令人满意，对初始模型进行了改进，最终保留了11个项目，最终模型的调整指数为χ2 = 127.53，χ2/gl = 2.89，RMSEA = 0.07，IC RMSEA为0.06至0.09，TLI = 0.95，CFI = 0.96，克朗巴哈α系数和麦克唐纳ω系数的内部一致性为0.93。由于进行了改进，对大多数项目具有合适拟合优度标准的情况下进行了新的验证性因子分析（χ2 = 151.44，χ2/gl = 3.43，RMSEA = 0.13，IC RMSEA为0.11至0.16，TLI = 0.93，CFI = 0.94），得到克朗巴哈α系数和麦克唐纳ω系数为0.98。
该工具具有合适的心理测量特性，可用于衡量医疗护理以患者为中心的程度。该工具代表了促进创新医疗保健模式的一种策略。
