Development Of Evaluation Index System For Effectiveness Of Transitional Care For Kidney Transplant Recipients

Objective This study was based on the Omaha system,using the Delphi method combined with the analytic hierarchy process to construct an evaluation index system for effectiveness of transitional care for kidney transplant recipients and determine the index weights.The reliability and validity of the index system were analyzed to preliminarily test the scientificity of the index system.It aimed to provide a reference for clinical evaluation of the effect of transitional care for kidney transplant recipients,and to provide a decision-making basis for the formulation of the next nursing plan and the improvement of nursing quality.Method An index system for the evaluation of transitional care of kidney transplant recipients was preliminarily formulated based on the Omaha system,literature review and semi-structured interviews.The Delphi method was used to conduct two rounds of expert letter inquiries to 21 experts to establish an evaluation index system for effectiveness of transitional care for kidney transplant recipients.The analytic hierarchy process was used to set the weights of the index system.A self-assessment questionnaire was developed based on the index system,and 288 kidney transplant recipients in a tertiary hospital in Anhui Province were investigated to test the reliability and validity of the index system by using internal consistency reliability,content validity and structural validity.Result1.The first draft of the evaluation index system for transitional care effectiveness of kidney transplant recipients included 5 first-level indicators,19 second-level indicators,and 61 third-level indicators.19 experts responded,and the experts of two rounds were the same.The effective questionnaire response rates of the two rounds were 90.5% and 100% respectively,and the expert authority coefficient was 0.897.After the second round of expert letter inquiries,the coordination coefficients of indicators at all levels were 0.235?0.336(P<0.05).Finally,an evaluation index system for the transitional care effectiveness of kidney transplant recipients with 5 primary indicators,16 secondary indicators and 48 tertiary indicators was formed.2.The consistency ratio CR of all levels of the evaluation index system for the transitional care effectiveness of kidney transplant recipients was 0.000～0.054,all <0.1.The first-level indicators were social environment,physiology,psychology,health behavior related fields,and satisfaction and their weights were 0.142,0.299,0.299,0.201,0.060 respectively.Among them,the highest weight in the social environment field was “medical resource utilization”(0.077),the highest weight in the physiological field was “positive mental state”(0.224),and the highest weight in the physiological field was “transplant kidney function”(0.134).The highest weighting in the health behavior related fields were "medication-related compliance" and "regular follow-up and self-monitoring"(both 0.068),and the highest weighting in the satisfaction field was "transitional care "(0.045).3.The overall Cronbach’s α coefficient of the evaluation index system for the transitional care effectiveness of kidney transplant recipients was 0.877,and the Cronbach’s α coefficient of the social environment,psychology,physiology,health-related behaviors,and satisfaction fields ranged from 0.587 to 0.903;The overall content validity index was 0.972,and the content validity index of each item ranged from 0.833 to 1.000;the correlation coefficient between each first-level index and the overall was 0.656 to 0.878(P<0.05).Conclusion1.The constructed evaluation index system for the transitional care effectiveness of kidney transplant recipients is based on the Omaha system as the theoretical framework,combined with literature analysis and the results of kidney transplant recipient interviews,and the content is scientific,comprehensive and disease-specific.2.The authoritative and representative of the experts selected for the research are good,and the consultation results were reliable;the combined application of the analytic hierarchy process and the results of the second round of expert letter inquiries increased the scientificity and reliability of the weight in the evaluation index system for the transitional care effectiveness of kidney transplant recipients.3.It was shown that the evaluation index system for the transitional care effectiveness of kidney transplant recipients had good reliability and validity,which can be used as an effective measurement tool to evaluate the continuous care effectiveness of kidney transplant recipients.