背景:护理环境显著影响患有严重精神疾病的患者的体验和护理质量。虽然欢迎和刺激的环境提高了患者的满意度和健康结果,精神科设施通常优先考虑员工工作流程而不是患者需求。应对这些挑战对于改善患者的精神卫生保健体验和结果至关重要。
目的:这项研究是改善精神健康护理质量的患者报告体验措施(PREMIUM)项目的一部分,旨在建立一个项目库(PREMIUM-CE)并开发计算机化的适应性测试(CATS)来衡量成年精神分裂症患者的护理环境体验,双相情感障碍,或重度抑郁症。
方法:我们进行了心理测量分析,包括对项目反应理论(IRT)模型假设的评估,IRT模型拟合,差分项功能(DIF),项目银行有效性,和CAT模拟。
结果:在这项多中心横断面研究中,从门诊和住院患者中招募了498名患者。最终的PREMIUM-CE13项目库是足够一维的(近似均方根误差=0.082,95%CI0.067-0.097;比较拟合指数=0.974;Tucker-Lewis指数=0.968),并显示出与IRT模型的充分拟合(输入均方统计量介于0.7和1.0之间)。DIF分析显示,根据性别,没有项目偏见,卫生保健设置,诊断,或学习参与方式。PREMIUM-CE评分与满意度指标密切相关(r=0.69-0.78;P<.001),与生活质量指标相关较弱(r=0.11-0.21;P<.001)。CAT模拟显示CAT得分与完整项目库得分之间存在很强的相关性(r=0.98),约79.5%(396/498)的参与者获得了可靠的评分,平均7个项目。
结论:PREMIUM-CE题库及其CAT版本显示出出色的心理测量特性,使它们成为评估门诊和住院环境中患有严重精神疾病的成年人的患者对护理环境的体验的可靠措施。这些措施是对现有患者体验评估的宝贵补充,捕捉对患者真正重要的东西,并增强对他们的护理体验的理解。
背景:ClinicalTrials.govNCT02491866;https://clinicaltrials.gov/study/NCT02491866。
BACKGROUND: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care.
OBJECTIVE: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder.
METHODS: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations.
RESULTS: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items.
CONCLUSIONS: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences.
BACKGROUND: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.