The Development And Application Of Health Care Expectation Rating Scale

Objective:The expectation of Medical care is a reflection of residents' medical needs and aspirations,which is an important evidence for hospital management,health policy formulation and health service supply.The aims of this study are to development a reliability,validity scale for quantitative evaluate the medical care expectation with good reliability and to carry out relevant applied research by using the scale.Methods:1.Literature analysisIn order improve the research design,we widely search the related literature published or written both in China and aboard.Items of the medical care expectation are constructed by reference to the relevant literatures.2.Delphi consulateIn order to ensure the scientificity and representativeness of the residents' medical care expectation scale,this study has improved the Delphi consulting method.Twenty-five experts and Twenty-five ordinary residents were invited to participate the consultation.Two groups' consultations were carried out simultaneously and analyzed respectively.3.Comprehensive method for item analysisIn order to select the representative,Independence,operational good indicators,traditional method,such as critical ratio,correlation coefficient,coefficient of variation method,factor analysis were used to analyze the medical care expectation indicators qualitatively and quantitatively.4.Analytic Hierarchy Process(AHP)The AHP judgment matrix were constructed by the experts' evaluation.Two domains and six dimensions' weight of the medical care expectation index system were calculate by the AHP.5.Field investigationReliability and validity of the scale were evaluated by field investigation.The sample for the field investigation were selected by the stratified cluster random sampling method.6.Empirical researchTo explore the influence factors for medical care expectation scale,we had conduct an empirical research.And to verify the relevant theoretical assumptions,relationship between medical care expectations and patient satisfaction were analyzed through the empirical research.Result:1.Index system's constructionEvaluation theory framework and the items' pool were constructed on the basis of analyzing the related literature and theories both in China and abroad.Two domain(medical-related and non-medical-related),6 dimensions(medical environment,quality of personnel,medical services,supporting services,price,and treatment results)and 63 items were included in the index system.2.Delphi consultationThe Delphi consultation invited a total of 25 experts and 25 ordinary residents to participate.The participation coefficient of Pre-survey,first round and second round consultation are greater than 70%.The average coefficient of experts' authority were 0.803.the consistency coefficients of experts were all more than 0.7 in the last round.The advice of experts were more and more consistency in the three rounds.The level of consistency reached the level,which research requested.Finally,52 items were contained for further analysis.3.Testing and screening for the indicatorsAfter analyzed and tested by critical rate method,response rate method,variation method,collinearity method,correlation method,internal consistency method,some items were adjusted and 49 items were contained.Finally,56 items,which included 49 items and 7 general evaluation item,consisted the beta version of the Medical Care Expectation Rating Scale.4.Weight of scale's domain and dimensionThe weight of Medical-related domain and non-medical-related domain were 0.6735,0.3265.The weight of six dimensions(Medical care environment,quality of personnel,medical care process,supporting services,price charges,and diagnosis and treatment results)were 0.0755,0.0992,0.3801,0.0713,0.1797,and 0.1742 respectively.5.Evaluation of the scaleThe response rate was 88.34%and the average time of completion was 27.91±13.67 minutes.Split-half reliability:The scale were divided into two halves by items odd-even.The Cronbach's alpha of two halves were:0.965 and 0.963.The correlation coefficient of the two half-scale was 0.979.the Split-half reliability of the scale was 0.941.Internal consistency reliability:The Cronbach's alpha of the scale was:0.982;The Cronbach's alpha of two domains and six dimensions are between 0.840 and 0.969.Test-retest reliability:The response rate of retest was 94%.The correlation coefficient of Scale score between twice test is 0.872.And the correlation coefficient of six dimensions' score between were all greater than 0.8.Content validity:The S-CVI of the scale is 0.873.All items' I-CVI are greater than 0.78.Kappa values are greater than 0.74.It can be considered that the scale have a good content validity.Structural validity:KMO test showed that Kaiser-Meyer-Olkin index = 0.956,Bartlett's test value is 11188.904,P<0.000,both supporting for factor analysis.The factor analysis for the scale revealed six factors with an Eigenvalue>1,explaining 57.14%of the total sample variance.After the component factor analysis using Varimax rotation,results show that:the first factor could be interpreted as medical care process(accounted for 55.712%of the variance);the second factor could be interpreted as diagnosis and treatment results dimension(accounted for 5.766%of the variance);The third factor could be interpreted as price dimensions(accounted for 4.212%of the variance);the fourth factor could be interpreted as Medical care environment dimension(accounted for 3.215%of the variance);the fifth factor could be interpreted as supporting services dimension(accounted for 2.365%of the variance);the sixth factor could be interpreted as quality of personnel dimension(accounted for 2.114%of the variance).Most of the items have fallen to the corresponding factors after the Varimax rotation of the variance,which is consistent with the theoretical structure design.Criterion validity:The correlation coefficient between every items and its'corresponding dimension were range from 0.500 to 0.702(P<0.05).And the correlation coefficient between the every dimensions and its single-evaluation item were all more than 0.60(P<0.05)6.Application(1)Research about the influencing factorsThe result of Univariate analysis and regression analysis showed that residents'personal health status,age,whether suffering from chronic diseases,health insurance type,sex,place of residence,occupation or profession,family per capita income,education have a certain impact on medical care expectations.And the regression model was valid.The result of the test for the regression model was:R2=0.5318 F=54.141,P=0.000,(2)Relationship between medical care expectation and patient satisfactionThere was a significant negative correlation between medical expectation and patient satisfaction score.The correlation coefficient was-0.638(P<0.05).The higher the expectation of medical care,the lower the patient satisfaction is.Conclusions:1.Indicators of medical care expectations have a good scientificity,representative and operability through a serious rigorous testing,screening.2.Reliability and validity of the medical care expectation scale were good,which meets the requirements of application.3.Numerous factors that play a role in the development of medical care expectation.Personal health status,age,chronic disease,type of medical insurance,gender and so on have certain influence on the expectation of medical care.4.There was a negative correlation between the expectation of medical treatment and the satisfaction of patients.Higher expectation could lead to the dissatisfaction of the patients.Creativities of the study:1)Innovative the Delphi method.In order to select more representative indicators and fully respect the feelings and opinions of the residents,ordinary residents were invited to participate the consultation.2)in order to more scientific and accurate result,analytic hierarchy process were used to calculate the weight of the scale's domains and dimensions.3)Established the first domestic medical care expectation evaluation scale and realized the quantitative evaluation of medical care expectation.4)Verified the relationship between medical care expectation and patient satisfaction.Provide the reference for building a harmonious medical environment.