Measuring practice capacity for change: a tool for guiding quality improvement in primary care settings.
Measuring practice capacity for change: a tool for guiding quality improvement in primary care settings.
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DOI：
10.1097/qmh.0b013e3181bee2f5
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发表时间：
2009-10-01
影响因子：
1.2
通讯作者：
Stange, Kurt C
中科院分区：
文献类型：
--
作者：
Bobiak, Sarah N;Zyzanski, Stephen J;Stange, Kurt C
目的：变革能力，或进行变革的能力和意愿，是一种有潜力促进医疗保健质量管理的组织特征。我们报告了初级保健机构中使用的变革能力定量测量的发展和心理测量特性。方法：在回顾之前的概念和实证研究之后，我们生成了 117 个评估组织结构、氛围和文化的项目。研究小组成员利用直接观察和关键知情人访谈获得的信息，对参与质量改进干预的 15 种初级保健实践的这些项目进行了评级。分布统计、成对相关分析、Rasch 建模和项目内容审查指导项目缩减和工具最终确定。评估了信度和收敛效度。结果：由于有限的响应分布和冗余或由于 Rasch 模型拟合不良，92 个项目被删除。最终仪器包含 25 个项目，具有出色的可靠性 (alpha = .94)。由 Rasch 模型得出的变革能力评分与独立确定的、定性得出的每个实践变革能力的总结评估 (rhoS = 0.82) 密切相关，表明具有良好的收敛效度。 结论：我们描述了一种用于量化初级保健环境中组织变革能力的新工具。量化变革能力的能力可以更好地识别在变革努力中可能成功的实践以及在变革干预之前首先需要能力建设的实践。
PURPOSE: Capacity for change, or the ability and willingness to undertake change, is an organizational characteristic with potential to foster quality management in health care. We report on the development and psychometric properties of a quantitative measure of capacity for change for use in primary care settings.METHODS: Following review of previous conceptual and empirical studies, we generated 117 items that assessed organizational structure, climate, and culture. Using information from direct observation and key informant interviews, a research team member rated these items for 15 primary care practices engaged in a quality improvement intervention. Distributional statistics, pairwise correlation analysis, Rasch modeling, and item content review guided item reduction and instrument finalization. Reliability and convergent validity were assessed.RESULTS: Ninety-two items were removed because of limited response distributions and redundancy or because of poor Rasch model fit. The final instrument comprising 25 items had excellent reliability (alpha = .94). A Rasch model-derived capacity for change score correlated well with an independently determined, qualitatively derived summary assessment of each practice's capacity for change (rhoS = 0.82), suggesting good convergent validity.CONCLUSION: We describe a new instrument for quantifying organizational capacity for change in primary care settings. The ability to quantify capacity for change may enable better recognition of practices likely to be successful in their change efforts and those first requiring capacity building prior to change interventions.