病人報告醫院品質的問卷發展與信效度分

Development and validation of the questionnaire for patient-reported hospital quality

目標：1990年代起，病人權益逐漸受到照護提供者重視，醫療品質的測量從採取照護提供者的觀點，逐漸走向病人觀點。相較於歐美國家，亞洲國家用來測量病人就醫經驗的工具相對較少。本文為發展適合臺灣病人住院經驗調查的測量工具。方法：以多元調查方式收集資料，共回收11,202份有效問卷，並以項目分析、信度以及探索性因素分析的結果選取問卷題目，並以驗證性因素分析檢驗問卷效度。結果：病人住院經驗問卷共23題，包含六個面向：醫師照護、護理照護、醫病互動、尊重與心理支持、醫院環境與出院準備服務。信度方面，病人住院經驗六個面向Cronbach’s值介0.69至0.88之間，顯示內部一致性尚屬適切。效度方面，採用驗證性因素分析驗證病人住院經驗六因素模型的適配度，該模型通過適配度的檢定，顯示模型的建構效度良好。結論：本量表有良好信度與效度，可供醫院與衛生主管機關了解病人住院經驗，作為改善醫院照護品質之參考。

Objectives: Since the 1990s, patient rights have garnered an increasing amount of attention from health-care providers. Assessments of health quality, which were traditionally conducted from the perspective of health-care providers, have gradually become more focused on the perspectives of patients. The current study developed a measurement tool specifically designed for evaluating inpatient experiences in Taiwan. Methods: Data were collected using various survey methods, with 11,202 valid questionnaire responses obtained. The selection of questionnaire items involved item analysis, reliability assessments, exploratory factor analysis, and confirmation of the questionnaire validity through confirmatory factor analysis. Results: In all, 23 questionnaire items focusing on inpatient experiences were selected, with these items spanning 6 dimensions, namely, physician care, nursing care, interaction with professionals, respect and mental support, hospital environment, and discharge plan. The Cronbach’s alpha values for each dimension ranged from 0.69 to 0.88, indicating acceptable reliability. The results of the confirmatory factor analysis revealed the data to have a good fit, affirming the strong discriminant validity of the inpatient experience dimensions. Conclusions: The questionnaire developed in this study exhibited satisfactory reliability and validity. This instrument may assist Taiwanese hospitals and health authorities in understanding patient experiences and in improving the quality of health care.