医养护一体化家庭医生式养老服务内容量表的构建研究

doi:10.12114/j.issn.1007-9572.2020.00.302

摘要/Abstract

摘要： 背景　近年来我国集医疗、养老、护理为一体的社区老年服务逐渐成为发展趋势，新型的社区老年健康服务更加适应当前老年人的健康需求，社区医养护一体化健康服务就近原则，可为自理能力较差的老年人采取上门服务，社会认可度高。但是，目前针对该服务需求内容的研究较少。目的　构建医养护一体化家庭医生式养老服务内容量表。方法　通过文献检索（2017年11—12月）、半结构化访谈（2018年1—3月），初步构建项目内容并编制专家函询问卷，2018年3—4月采用德尔菲法函询18名专家（从事全科医学、老年临床医学与护理、社区护理管理与教育、康复医疗、科研教育领域），构建医养护一体化家庭医生式养老服务内容量表。2018年4—10月采用便利抽样法抽取武汉市东西湖区、江岸区、硚口区的200名60岁及以上听力、视力、认知功能正常及自愿参与的老年人进行预调查，检验医养护一体化家庭医生式养老服务内容量表信效度。结果　两轮专家函询的专家积极系数分别为100.0%和94.4%，专家的权威系数分别为0.836和0.906，最终确立的医养护一体化家庭医生式养老服务内容量表，包含6个一级指标（基本医疗服务、国家基本公共卫生服务、健康管理、家庭病床、康复保健服务、健康指导）、38个二级指标；二级指标的必要性、可行性、风险性协调系数分别为0.109、0.113、0.305（P<0.01）。经预调查测算Cronbach's α系数为0.968，平均量表水平的内容效度指数（S-CVI/Ave）为0.941。结论　医养护一体化家庭医生式养老服务内容量表具有较好的信效度，可为制定家庭医生式养老服务项目提供参考。

关键词: 老年人保健服务；医师, 家庭；居家养老；医养结合；德尔菲技术

Abstract: Background　A recently emerged new type of community-based elderly care in China，which integrates nursing services into medical and elderly care services，has become a trend and an increased choice. The services can be accessed conveniently. So，this type of services has gained high social recognition. However，there is few research on the content of the service requirements. Objective　To develop a family doctor-led team-based in-home medical and nursing elderly services scale. Methods　The items of the draft were formulated based on document retrieval conducted between November and December 2017 and semi-structured interviews conducted between January and March 2018. Then in March and April，2018，using the questionnaire developed by our research group，two rounds of Delphi consultations were carried out with 18 experts（in general medicine，clinical geriatric medicine and nursing，community-based nursing management and education，rehabilitation medicine，or scientific research and education）. After being revised according to the consultation results，the draft was developed to be the family doctor-led team-based in-home medical and nursing elderly services scale，and then its reliability and validity were pretested between April and October in a voluntary convenient sample of 200 elderly people with normal hearing，sight and cognitive function（≥60 years old） from Dongxihu，Jiang'an and Qiaokou Districts of Wuhan City. Results　The response rate and average authoritative coefficient were 100.0% and 0.836，respectively，for the first round of consultation，and were 94.4% and 0.906，respectively，for the second round of consultation. The final scale consisted of 6 first-level indicators（basic medical care，basic public health services，health management，family ward，rehabilitation health services and health guidance），and 38 second-level indicators（with Kendall's W of 0.109，0.113，0.305 for necessity，feasibility and risk，respectively，P<0.01）. The Cronbach's α coefficient and content validity index of the scale estimated based on the survey were 0.968，and 0.941，respectively. Conclusion　The scale developed by us showed good reliability and validity in the survey，which can be used as a reference for the formulation of family doctor-led team-based elderly services.

Key words: Health services for the aged；Physicians, family；Community home-care；Combination of medical and endowment；Delphi technique

陈小杭,钟文娟,向双琼,等. 医养护一体化家庭医生式养老服务内容量表的构建研究[J]. 中国全科医学, 2020, 23(28): 3546-3552. DOI: 10.12114/j.issn.1007-9572.2020.00.302.
CHEN Xiaohang,ZHONG Wenjuan,XIANG Shuangqiong, et al. Development of the Family Doctor-led Team-based In-home Medical and Nursing Elderly Services Scale　[J]. Chinese General Practice, 2020, 23(28): 3546-3552. DOI: 10.12114/j.issn.1007-9572.2020.00.302.

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