Individualization and Quality Improvement: Two New Scales to Complement Measurement of Program Fidelity
Individualization and Quality Improvement: Two New Scales to Complement Measurement of Program Fidelity
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DOI：
10.1007/s10488-009-0226-y
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发表时间：
2009-09-01
影响因子：
2.6
通讯作者：
Xie, Haiyi
中科院分区：
文献类型：
--
作者：
Bond, Gary R.;Drake, Robert E.;Xie, Haiyi
忠诚度量表已被广泛用于评估项目对循证实践原则的遵守情况，但它们并不能衡量护理质量的重要方面。测量临床服务质量的实用尺度需要补充保真度尺度测量项目实施的结构方面。作为为国家实施循证实践项目开发的仪器的一部分，我们试用了一种新仪器，其中包括两个5项质量量表，个性化（客户级质量量表）和质量改进（组织级质量量表）。成对的独立保真度评估员在8个州的49个站点进行了基线保真度审查，并在随后的4个6个月间隔超过2年的随访期。评估员遵循标准化的协议，在为期一天的现场访问期间管理这些质量量表;在这些相同的访问期间，他们评估了该网站正在寻求实施的基于证据的实践的忠实性计划。评估者在个性化和质量改进方面都达到了可接受的评价者间可靠性。主成分因子分析证实了2尺度结构。这两个量表适度相互关联，并与循证实践保真度量表。在第一年，个性化和质量改进有所改善，但在最后一年的随访中几乎没有改善。这两个新开发的量表在这项初步研究中显示出足够的心理测量特性，但需要进一步的研究来评估其在常规临床实践中的有效性和实用性。
Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.