用于急诊和紧急护理环境的诊断卓越患者报告衡量标准的制定和心理测量学分析。
Development and Psychometric Analysis of a Patient-Reported Measure of Diagnostic Excellence for Emergency and Urgent Care Settings.
机构信息
From the Johns Hopkins University School of Nursing, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
出版信息
J Patient Saf. 2024 Oct 1;20(7):498-504. doi: 10.1097/PTS.0000000000001271. Epub 2024 Aug 28.
BACKGROUND
Emergency and urgent care settings face challenges with routinely obtaining performance feedback related to diagnostic care. Patients and their care partners provide an important perspective on the diagnostic process and outcome of care in these settings. We sought to develop and test psychometric properties of Patient-Report to IMprove Diagnostic Excellence in Emergency Department settings (PRIME-ED), a measure of patient-reported diagnostic excellence in these care settings.
METHODS
We developed PRIME-ED based on literature review, expert feedback, and cognitive testing. To assess psychometric properties, we surveyed AmeriSpeak, a probability-based panel that provides sample coverage of approximately 97% of the U.S. household population, in February 2022 to adult patients, or their care partners, who had presented to an emergency department or urgent care facility within the last 30 days. Respondents rated their agreement on a 5-point Likert scale with each of 17 statements across multiple domains of patient-reported diagnostic excellence. Demographics, visit characteristics, and a subset of the Emergency Department Consumer Assessment of Healthcare Providers & Systems were also collected. We conducted psychometric testing for reliability and validity.
RESULTS
Over a thousand (n = 1116) national panelists completed the PRIME-ED survey, of which 58.7% were patients and 40.9% were care partners; 49.6% received care at an emergency department and 49.9% at an urgent care facility. Responses had high internal consistency within 3 patient-reported diagnostic excellence domain groupings: diagnostic process (Cronbach's alpha 0.94), accuracy of diagnosis (0.93), and communication of diagnosis (0.94). Domain groupings were significantly correlated with concurrent Emergency Department Consumer Assessment of Healthcare Providers & Systems items. Factor analyses substantiated 3 domain groupings.
CONCLUSIONS
PRIME-ED has potential as a tool for capturing patient-reported diagnostic excellence in emergency and urgent care.
背景
急诊和紧急护理环境在常规获得与诊断护理相关的绩效反馈方面面临挑战。患者及其护理伙伴提供了这些环境中诊断过程和护理结果的重要视角。我们旨在开发和测试用于改善急诊部门（PRIME-ED）诊断卓越的患者报告，这是一种衡量这些护理环境中患者报告的诊断卓越的衡量标准。
方法
我们基于文献综述、专家反馈和认知测试开发了 PRIME-ED。为了评估心理测量特性，我们于 2022 年 2 月对 AmeriSpeak 进行了调查，这是一个基于概率的小组，提供了美国家庭人口的约 97%的样本覆盖范围，对象是在过去 30 天内到急诊部门或紧急护理机构就诊的成年患者或其护理伙伴。受访者在 5 点李克特量表上对 17 个陈述的多个患者报告的诊断卓越领域进行了评分。还收集了人口统计学、就诊特征和急诊部医疗保健提供者和系统消费者评估的一个子集。我们进行了可靠性和有效性的心理测量测试。
结果
超过一千名（n=1116）全国小组参与者完成了 PRIME-ED 调查，其中 58.7%是患者，40.9%是护理伙伴；49.6%在急诊部门接受治疗，49.9%在紧急护理机构接受治疗。在 3 个患者报告的诊断卓越领域分组内，响应具有很高的内部一致性：诊断过程（Cronbach 的 alpha 0.94）、诊断准确性（0.93）和诊断沟通（0.94）。域分组与同期急诊部医疗保健提供者和系统消费者评估项目显著相关。因子分析证实了 3 个域分组。
结论
PRIME-ED 有可能成为一种工具，用于在急诊和紧急护理中捕捉患者报告的诊断卓越。
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