Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana
Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana
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DOI：
10.1007/s00268-010-0918-1
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发表时间：
2011-03-01
影响因子：
2.6
通讯作者：
Abdullah, Fizan
中科院分区：
文献类型：
--
作者：
Osen, Hayley;Chang, David;Abdullah, Fizan
世界卫生组织（世卫组织）评估紧急和基本外科护理的情况分析工具（以下简称世卫组织工具）已在超过25个国家使用，是世界上评估外科护理的最大努力。然而，它尚未得到独立验证。重测信度是验证测试工具在多大程度上不受随机误差影响的一种方法。本实地研究的目的是确定世卫组织工具的重测信度，世卫组织工具已邮寄给加纳的10家地区医院。沿着提供了加纳卫生服务局的一封信，要求医院管理人员完成调查工具。在确保交付和填写表格后，研究小组在不到1个月后的现场访问时重新使用世卫组织工具。比较两个测试的结果，以计算WHO工具中152个问题中每个问题的Kappa统计量。Kappa统计量是一种统计学指标，用于衡量协议程度是否高于仅基于偶然性的预期。不到一个月）。计算了152个问题的加权和未加权Kappa统计量。整个调查的中位数未加权Kappa值为0.43（四分位数范围0-0.84）。基础设施科（24个问题）的Kappa中位数为0.81;人力资源部分（13个问题）的Kappa中位数为0.77;外科手术部分（67个问题）的Kappa中位数为0.00;和紧急手术设备部分（48个问题）的Kappa值中位数为0.81。与基础设施特征相关的医院能力调查问题具有较高的信度。然而，与护理过程相关的问题可靠性较差，可能会受益于通过直接观察收集的补充数据。该研究的局限性包括样本量小：一个国家的10家地区医院。一致的和高的相关性计算的现场测试在本分析表明，世卫组织的情况分析工具是一个可靠的工具，它的措施结构和设置，但它应修订测量过程的护理。
The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test-retest reliability is one way to validate the degree to which tests instruments are free from random error. The aim of the present field study was to determine the test-retest reliability of the WHO Tool.The WHO Tool was mailed to 10 district hospitals in Ghana. Written instructions were provided along with a letter from the Ghana Health Services requesting the hospital administrator to complete the survey tool. After ensuring delivery and completion of the forms, the study team readministered the WHO Tool at the time of an on-site visit less than 1 month later. The results of the two tests were compared to calculate kappa statistics for each of the 152 questions in the WHO Tool. The kappa statistic is a statistical measure of the degree of agreement above what would be expected based on chance alone.Ten hospitals were surveyed twice over a short interval (i.e., less than 1 month). Weighted and unweighted kappa statistics were calculated for 152 questions. The median unweighted kappa for the entire survey was 0.43 (interquartile range 0-0.84). The infrastructure section (24 questions) had a median kappa of 0.81; the human resources section (13 questions) had a median kappa of 0.77; the surgical procedures section (67 questions) had a median kappa of 0.00; and the emergency surgical equipment section (48 questions) had a median kappa of 0.81.Hospital capacity survey questions related to infrastructure characteristics had high reliability. However, questions related to process of care had poor reliability and may benefit from supplemental data gathered by direct observation. Limitations to the study include the small sample size: 10 district hospitals in a single country. Consistent and high correlations calculated from the field testing within the present analysis suggest that the WHO Tool for Situational Analysis is a reliable tool where it measures structure and setting, but it should be revised for measuring process of care.