中国全科医学 ›› 2023, Vol. 26 ›› Issue (04): 477-485.DOI: 10.12114/j.issn.1007-9572.2022.0645

• 论著·全科医生岗位胜任力专题研究 • 上一篇    下一篇

签约服务情境下全科医生岗位胜任力自评量表的开发与信效度检验

马志强*(), 张宝丽, 郭乐   

  1. 212013 江苏省镇江市,江苏大学管理学院
  • 收稿日期:2022-09-08 修回日期:2022-10-23 出版日期:2023-02-05 发布日期:2022-11-03
  • 通讯作者: 马志强
  • 马志强,张宝丽,郭乐.签约服务情境下全科医生岗位胜任力自评量表的开发与信效度检验[J].中国全科医学,2023,26(4):477-485.[www.chinagp.net]
    作者贡献:马志强负责总体研究目标的制定,文章的构思、设计与指导,为研究课题提供资金支持并进行质量控制、审校与监督管理;张宝丽进行论文撰写与修订,对文章整体负责;郭乐进行资料收集整理、数据分析与文章修订。
  • 基金资助:
    国家自然科学基金面上项目——全科医生胜任力与居民签约服务利用意愿的耦合机制及提升策略研究(71974082); 国家自然科学基金面上项目(71573109)——全科医生服务价值实现的机理与策略研究(71573109); 江苏大学第20批大学生科研课题立项资助项目(20C445)

Development, Reliability and Validity of the General Practitioner Competency Rating Scale for Assessing General Practitioners' Competencies in Delivering Contracted Healthcare Services

MA Zhiqiang*(), ZHANG Baoli, GUO Le   

  1. School of Management, Jiangsu University, Zhenjiang 212013, China
  • Received:2022-09-08 Revised:2022-10-23 Published:2023-02-05 Online:2022-11-03
  • Contact: MA Zhiqiang
  • About author:
    MA Z Q, ZHANG B L, GUO L. Development, reliability and validity of the General Practitioner Competency Rating Scale for assessing general practitioners' competencies in delivering contracted healthcare services[J]. Chinese General Practice, 2023, 26 (4) : 477-485.

摘要: 背景 随着我国基层医疗卫生机构全科医生签约服务的启动和落实,全科医生岗位胜任力逐渐成为国家推进分级诊疗、实现基层医疗卫生服务有效供给的基础。目标明确、操作性强并以胜任力为导向的日常考核和评价机制,能够正向激励全科医生的工作并促进签约服务不断提质增效。 目的 编制全科医生岗位胜任力自评量表,为科学评价我国全科医生的岗位胜任能力提供适用的工具。 方法 基于全科医生岗位胜任力模型,通过文献回顾并参考相关岗位胜任力量表进行了测量题项拟定和初始量表设计。并于2021年4—8月对全国主要省级行政区域的基层全科医生进行问卷调查,最终收集了402份有效问卷数据。将有效样本(n=402)平均随机分为两部分,样本A(n=201)用于探索性因子分析,样本B(n=201)用于验证性因子分析,并在此基础上对最终量表进行了信效度检验。 结果 最终的全科医生岗位胜任力量表包括4个维度(全科服务能力、人文执业能力、团队协作能力、学习发展能力)、21个条目。总量表的Cronbach's α系数为0.929,全科服务能力、人文执业能力、团队协作能力、学习发展能力4个维度的Cronbach's α系数分别为0.877、0.850、0.812、0.811。Bartlett's球形检验结果显著(近似χ2=2 319.759,P<0.001),KMO检验值为0.923,探索性因子分析共提取了4个共同因子,累积方差贡献率为67.680%。一阶验证性因子显示4个维度相关系数为0.68~0.72,量表因子之间存在较高的相关性。二阶验证性因子分析的结果为:χ2/df=1.312,近似误差均方根(RMSEA)=0.039,比较拟合指数(CFI)=0.976,拟合优度指数(GFI)=0.913,规范拟合指数(NFI)=0.907。 结论 本研究构建的全科医生岗位胜任力量表具有较好的信度和效度,可为我国签约服务情景下全科医生岗位胜任力评价提供依据。

关键词: 全科医生, 岗位胜任力, 家庭医生签约服务, 量表, 信度, 效度

Abstract:

Background

The competencies of general practitioners (GPs) have become a basis for promoting the implementation of tiered diagnosis and treatment, and effective supply of primary healthcare services against the backdrop of the initiation and implementation of contracted services provided by GPs in primary care in China. The regular competency-based assessment systems with clear objectives and strong operability can positively stimulate GPs to provide contracted services with higher quality and efficiency.

Objective

To develop a competency rating scale for GPs, providing a tool applicable to scientific evaluation of GPs' competencies in China.

Methods

By use of a GP competency model, and review results of relevant studies and competency scales, the measurement items and the draft of the scale were developed, then were revised according to the results of a questionnaire survey conducted with GPs in primary care in major provincial administrative regions from April to August 2021. Among the 402 responders, the answers of 201 cases (sample A) were used for exploratory factor analysis, and those of the other 210 cases (sample B) were used for confirmatory factor analysis. Based on this, the reliability and validity of the final scale were tested.

Results

The final General Practitioner Competency Rating Scale includes four dimensions (general service competency, humanistic competency during practice, teamwork and cooperation competency, learning and development competency) and 21 items. The Cronbach's α for the scale, and the afore-mentioned four dimensions was 0.929, 0.877, 0.850, 0.812, and 0.811, respectively. The P-value of Bartlett's test of sphericity was less than 0.001 (approximate χ2=2 319.759, P<0.001) , reaching a significant standard, and the KMO value (0.923) was close to 1.0. By exploratory factor analysis, four common factors were extracted, explaining 67.680% of the total variance. The first-order confirmatory factor analysis showed that the correlation coefficients of the four dimensions were between 0.68 and 0.72, and highly correlated. The second-order confirmatory factor analysis results were: χ2/df=1.312, RMSEA=0.039, CFI=0.976, GFI=0.913, NFI=0.907.

Conclusion

Our scale has proven to have good reliability and validity, which may be used for assessing the competencies of GPs delivering contracted services in China.

Key words: General practitioners, Competency, Contracted family doctor services, Scaling, Reliability, Validity