Further Psychometric Testing and Validation of the Errors of Care Omission Survey (EoCOS)

尽管很大一部分医疗保健是在初级保健环境中提供的，但对患者安全的研究 在初级保健方面落后于住院护理。患者安全问题在初级医院中同样频繁发生 在住院环境中的护理，但没有得到很好的研究。此外，现有的研究主要集中在偏误方面。 佣金-做错事，如服用错误的药物-相对于错误的 疏忽-行动失败，如错过护理。尽管遗漏错误多于委托错误，但 威胁到患者的安全，在关于遗漏错误的文献中有一个严重的空白。这种证据的缺乏限制了 临床实践的评价和对管理者、决策者和临床医生能力的挑战 促进患者安全的变化。目前还没有可靠有效的工具来测量护理疏忽的差错 初级保健。我们正在通过文献回顾开发护理疏忽差错调查(EoCOS)， 调查现有工具、与初级保健提供者(PCP)面谈、内容验证和预测试 测量PCP对护理疏忽错误的知觉。提出了护理遗漏的四个基本领域： A)自我管理支持；b)后续行动；c)情绪健康；d)护理整合。每个EoCOS分量表 通过要求PCP在4分制上对他们的感知进行评级的项目来衡量一个领域。目的 建议的研究是为了进一步评估EoCOS的心理测量特性，并提炼和验证 工具。具体目标包括1)确定EoCOS的因子结构，并最终确定测量分量表 护理遗漏领域；2)使用项目反应理论(IRT)调查EoCOS项目的绩效 模型；以及3)检查每个EoCOS子量表上的项目是否通过拟合测量预期结构 使用验证性因素分析(CFA)从不同的初级保健医生那里收集数据。一种横断面测量设计 将使用在纽约州招聘的初级保健医生(医生和护士从业人员)的样本(n=1,328)。每个人 PCP将收到一份邮寄的调查问卷，以及求职信、同意书和一个预付邮资的返还信封 将调查结果返还给研究团队。邮政署会发出明信片提醒及第二次邮寄，以 提高应答率。数据分析将使用SPSS、MPlus和IRTPro软件。我们会随机 将样本分成两部分：派生样本和验证样本。使用派生示例中的数据，我们将 用探索性因子分析建立EoCOS的因子结构并评价其特征 使用项目反应理论模型对每个单独的项目进行评估。使用验证样本，我们将测试 出现的因素结构与本样本的数据相吻合。这些分析程序将评估 EoCOS的判别、收敛和结构效度，并将产生样本不变参数。 EoCOS可以与不同的PCP组一起使用，以进行有意义的护理遗漏比较 跨实践和州的错误增加了该工具的实用性。这一证据将有助于确保患者的安全 初级保健中的系统，使保健遗漏错误可见，以便在伤害患者之前得到纠正。

Although a large proportion of healthcare care is delivered in primary care settings, research on patient safety in primary care has lagged behind that of inpatient care. Patient safety issues occur as frequently in primary care as in inpatient settings, but are not well studied. Moreover, the extant studies mainly focus on errors of commission—doing something wrong such as administering wrong medication—as opposed to errors of omission—failure of action such as missed care. Although omission errors outnumber commission errors and threaten patient safety, there is a critical gap in the literature on omission errors. This lack of evidence restricts the evaluation of clinical practice and challenges administrators', policy makers' and clinicians' abilities to make changes to promote patient safety. There are no reliable and valid tools to measure errors of care omission in primary care. We are developing the Errors of Care Omission Survey (EoCOS) through literature review, investigation of existing tools, interviews with primary care providers (PCPs), content validation, and pretesting to measure PCP perceptions of errors of care omission. Four domains underlying care omission are proposed: a) self-management support; b) follow-up; c) emotional health; and d) care integration. Each EoCOS subscale measures one domain through items asking PCPs to rate their perceptions on a 4-point scale. The purpose of the proposed study is to further evaluate the psychometric properties of the EoCOS and refine and validate the tool. Specific aims include 1) Determine the factorial structure of EoCOS and finalize the subscales measuring care omission domains; 2) Investigate performance of the items in EoCOS using Item Response Theory (IRT) models; and 3) Examine whether the items on each EoCOS subscale measure the intended construct by fitting data from different PCPs utilizing Confirmatory Factor Analysis (CFA). A cross-sectional survey design with a sample of PCPs (physicians and nurse practitioners) recruited in New York State will be used (n=1,328). Each PCP will receive a mailed survey along with cover letter, consent form, and a prepaid return envelope for returning the surveys to the research team. Post card reminders and a second mailing will be conducted to increase the response rate. SPSS, MPlus and IRTPro software will be used for data analysis. We will randomly split the sample into two: a derivation and a validation sample. Using data from the derivation sample, we will establish the factorial structure of the EoCOS using Exploratory Factor Analysis and assess the characteristics of each individual item using Item Response Theory models. Using the validation sample, we will test whether the emerged factor structure fits the data from this sample. These analytical procedures will assess the discriminant, convergent, and construct validity of the EoCOS and will produce sample invariant parameters. EoCOS may be used with various groups of PCPs for conducting meaningful comparisons of care omission errors across practices and states increasing the utility of the tool. This evidence will help create patient safety systems in primary care to make care omission errors visible so they can be corrected before harming patients.