病患觀點之門診照護連續性與照護協調性的測量工具：臺灣版問卷發展與信效度分析

Outpatient Care Continuity and Coordination Assessment Questionnaire from Patient Perspective in Taiwan: Development and Testing of Reliability and Validity

目標：發展一套適用於臺灣，從病患觀點來評估門診照護連續性與照護協調性的測量工具（Outpatient Care Continuity and Coordination Assessment, OCCCA），並蒐集信效度證據。方法：以臺灣社區50歲以上民眾為母體，進行分層多階段等比例抽樣選出樣本，以面訪方式進行調查，共計有179位民眾完成調查，回收率41.15％。以項目、信度及效度的分析結果選取題目，並蒐集信效度證據。信度分析採用Cronbach’s值驗證量表之內部一致性；效度採用驗證性因素分析與區辨效度進行驗證。結果：此核心測量工具計有15題。分析發現照護連續性與照護協調性兩個概念為中度相關，照護連續性包含醫病長期關係、資訊流通與人際互動三面向，而照護協調性包含醫生間資訊流通與溝通合作兩面向。信度方面，照護連續性和照護協調性面向的Cronbach’s值介於0.64～0.83之間，尚屬適切。效度方面，照護連續性之三因素模型或協調性的兩因素模型，均通過模型的適配度檢定，顯示效度良好。結論：本研究發展之民眾觀點門診照護連續性與照護協調性的測量工具，具有適切的信度與效度，未來可作為評估此兩項概念的工具。

Objective. To develop and test the reliability and validity of the Outpatient Care Continuity and Coordination Assessment (OCCCA) Questionnaire in Taiwan. Method. A nationwide fifty-year-old people face-to-face interview was conducted for community-dwelling subjects selected via a stratified multistage proportional to the sizes sampling process. A total of 179 subjects completed the questionnaire with a response rate of 41.15%. The core items of the OCCCA questionnaire were selected via the process of item analysis, reliability and validity testing. Reliability was assessed by Cronbach's to measure the internal consistency. Validity was examined by confirmatory factor analysis and discriminant validity measures. Results. A total of 15 core items were selected and finalized. The results revealed that the concept of care continuity was moderately correlated with the concept of care coordination. The care continuity included three dimensions: longitudinal relationship, information transfer and interpersonal relationship between patient and their doctor; while care coordination included two dimensions: information transfer and communication/cooperation among physicians. The value of Cronbach's for each dimension of the care continuity and care coordination ranged from 0.64 to 0.83 which indicated acceptable reliability. Results of confirmatory factor analysis showed that the dimensions of both care continuity and care coordination fitted the data well which indicated good validity. Conclusions. The OCCCA questionnaire seemed to be a comprehensive, reliable and valid instrument which can be applied to measure care continuity and care coordination in outpatient settings from patient perspective.