장기요양시설에서의 노인의 서비스 경험의 측정은 노인의 저하된 인지 능력에도 불구하고 그들의 관점을 중요시하고, 서비스 경험측정 결과를 질 향상의 출발점으로 활용할 수 있다는 점에서 그 중요성이 높아지고 있다. 본 연구는 장기요양시설 노인의 서비스 경험 측정지표를 개발하기 위한 방법론적 연구로 장기요양시설 노인의 서비스 경험의 구성요인을 규명하고, 예비문항을 작성하는 개발 단계와 도구의 타당도 및 신뢰도를 검증하는 검증단계로 진행되었다.
개발단계에서는 문헌고찰과 장기요양시설 노인 14명에게 개념도 방법을 적용하여 구성요인을 규명하였다. 이 단계를 통하여 개념도 방법을 통해 도출된 돌봄 및 처치의 안전성, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕, 존중과 의사소통, 참여와 선호반영 6가지 범주와 본 연구의 개념적 기틀인 질 보장 케어 개념 틀(QFRC)의 9가지 영역을 통합하여 돌봄(처치)의 안전성 및 전문성, 신체적 안녕감, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕감, 의사소통과 정보, 참여 및 선호 반영 등 본 연구의 7가지 구성요인을 도출하였다.
선행연구, 기존도구와 개념도 방법을 통해 작성된 64개의 예비문항에 대하여 간호학 교수 3명, 7년 이상 장기요양 경험이 있는 사회복지사 2명, 장기요양시설 시설장 또는 3년 이상 경력이 있는 간호사 2명, 노인 보건 전공 보건학 교수 2명, 장기요양 관련 보건학 박사 1명 등 총 10명으로 구성된 전문가 집단에게 ...
장기요양시설에서의 노인의 서비스 경험의 측정은 노인의 저하된 인지 능력에도 불구하고 그들의 관점을 중요시하고, 서비스 경험측정 결과를 질 향상의 출발점으로 활용할 수 있다는 점에서 그 중요성이 높아지고 있다. 본 연구는 장기요양시설 노인의 서비스 경험 측정지표를 개발하기 위한 방법론적 연구로 장기요양시설 노인의 서비스 경험의 구성요인을 규명하고, 예비문항을 작성하는 개발 단계와 도구의 타당도 및 신뢰도를 검증하는 검증단계로 진행되었다.
개발단계에서는 문헌고찰과 장기요양시설 노인 14명에게 개념도 방법을 적용하여 구성요인을 규명하였다. 이 단계를 통하여 개념도 방법을 통해 도출된 돌봄 및 처치의 안전성, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕, 존중과 의사소통, 참여와 선호반영 6가지 범주와 본 연구의 개념적 기틀인 질 보장 케어 개념 틀(QFRC)의 9가지 영역을 통합하여 돌봄(처치)의 안전성 및 전문성, 신체적 안녕감, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕감, 의사소통과 정보, 참여 및 선호 반영 등 본 연구의 7가지 구성요인을 도출하였다.
선행연구, 기존도구와 개념도 방법을 통해 작성된 64개의 예비문항에 대하여 간호학 교수 3명, 7년 이상 장기요양 경험이 있는 사회복지사 2명, 장기요양시설 시설장 또는 3년 이상 경력이 있는 간호사 2명, 노인 보건 전공 보건학 교수 2명, 장기요양 관련 보건학 박사 1명 등 총 10명으로 구성된 전문가 집단에게 내용타당도 검증을 받아서 47개 문항을 선정하였다. 장기요양시설 노인을 대상으로 한 인지 면접과 사전조사 및 국문학자의 검토를 통하여 최종 45문항의 예비지표를 확정하였다.
예비지표의 신뢰도와 타당도를 검증하기 위하여 서울, 경기 및 충남 소재 시설 8곳에 거주하는 200명의 노인을 대상으로 설문조사를 실시하였다. 문항 분석을 통해 정규성 및 문항 간 상관관계 및 신뢰도를 해치는 문항을 검토하여 28 개의 문항을 추출하였다. 두 차례의 요인분석을 통해 총 14개 문항, 3개 요인을 추출하였으며 총 설명력은 51.89%이었다. 최대우도법과 직접 오블리민 회전 방법으로 3요인에 대한 모형적합도를 검증한 결과 카이제곱 값 48.558, 자유도 52, 유의수준 .610(p>.05), RMSEA=0으로 적합한 모델임이 검증되었다. 전문가의 내용타당도 검증을 통해 결정된 돌봄(처치)의 안전성과 전문성, 신체적 안녕감, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕감, 의사소통과 정보, 참여와 선호반영 등의 7가지 요인을 요인분석 결과에서 나타난 3개 요인으로 통합, 재구성하였으며, 각 요인에 속한 문항을 검토한 결과 최종 지표는 돌봄(처치)의 안전성 및 전문성, 책임감 있고 지지적인 직원, 참여 및 선호반영으로 명명하였다. 준거타당도 검증을 위하여 단축형 한국어판 사회복지서비스 이용자만족도 척도 (CSI-SF)도구와의 상관관계를 분석한 결과 본 연구에서 개발된 장기요양시설 노인의 서비스 경험 측정지표는 CSI-SF도구와 γ=.714(p<.001)의 높은 상관관계를 나타냈으며, 3개 하부영역은 γ=.475~.633의 상관관계를 나타냈다. 전체 14문항의 신뢰도는 Cronbach’s α 값이 .814였으며, 각 하부 요인별로는 돌봄(처치)의 안전성 및 전문성 요인은 .740, 책임감 있고 지지적인 직원 요인은 .719, 참여와 선호 반영 요인은 .709이었다. 평가자간 신뢰도 검정 결과 일치도 통계는 85~100%, 가중 Kappa값은 .643~1.00(p<.001), ICC는 .791~1.00으로 신뢰할 수 있는 수준이었다.
이상의 과정을 거쳐 3개 하위영역, 14문항으로 구성된 4점 척도의 자가보고 형태의 우리나라 장기요양시설 노인의 서비스 경험 측정지표를 개발하였다. 향후 본 지표를 활용하여 노인의 관점에서 서비스 경험을 측정함으로써 노인을 돌보는 간호 인력에 대한 교육 및 훈련 프로그램 구성에 참고할 수 있을 것이고 궁극적으로 장기요양시설 케어의 질 향상에 기여할 수 있을 것이며, 장기요양시설 노인의 서비스 경험 조사 및 중재 연구에 기초를 제공할 수 있을 것이다.
장기요양시설에서의 노인의 서비스 경험의 측정은 노인의 저하된 인지 능력에도 불구하고 그들의 관점을 중요시하고, 서비스 경험측정 결과를 질 향상의 출발점으로 활용할 수 있다는 점에서 그 중요성이 높아지고 있다. 본 연구는 장기요양시설 노인의 서비스 경험 측정지표를 개발하기 위한 방법론적 연구로 장기요양시설 노인의 서비스 경험의 구성요인을 규명하고, 예비문항을 작성하는 개발 단계와 도구의 타당도 및 신뢰도를 검증하는 검증단계로 진행되었다.
개발단계에서는 문헌고찰과 장기요양시설 노인 14명에게 개념도 방법을 적용하여 구성요인을 규명하였다. 이 단계를 통하여 개념도 방법을 통해 도출된 돌봄 및 처치의 안전성, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕, 존중과 의사소통, 참여와 선호반영 6가지 범주와 본 연구의 개념적 기틀인 질 보장 케어 개념 틀(QFRC)의 9가지 영역을 통합하여 돌봄(처치)의 안전성 및 전문성, 신체적 안녕감, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕감, 의사소통과 정보, 참여 및 선호 반영 등 본 연구의 7가지 구성요인을 도출하였다.
선행연구, 기존도구와 개념도 방법을 통해 작성된 64개의 예비문항에 대하여 간호학 교수 3명, 7년 이상 장기요양 경험이 있는 사회복지사 2명, 장기요양시설 시설장 또는 3년 이상 경력이 있는 간호사 2명, 노인 보건 전공 보건학 교수 2명, 장기요양 관련 보건학 박사 1명 등 총 10명으로 구성된 전문가 집단에게 내용타당도 검증을 받아서 47개 문항을 선정하였다. 장기요양시설 노인을 대상으로 한 인지 면접과 사전조사 및 국문학자의 검토를 통하여 최종 45문항의 예비지표를 확정하였다.
예비지표의 신뢰도와 타당도를 검증하기 위하여 서울, 경기 및 충남 소재 시설 8곳에 거주하는 200명의 노인을 대상으로 설문조사를 실시하였다. 문항 분석을 통해 정규성 및 문항 간 상관관계 및 신뢰도를 해치는 문항을 검토하여 28 개의 문항을 추출하였다. 두 차례의 요인분석을 통해 총 14개 문항, 3개 요인을 추출하였으며 총 설명력은 51.89%이었다. 최대우도법과 직접 오블리민 회전 방법으로 3요인에 대한 모형적합도를 검증한 결과 카이제곱 값 48.558, 자유도 52, 유의수준 .610(p>.05), RMSEA=0으로 적합한 모델임이 검증되었다. 전문가의 내용타당도 검증을 통해 결정된 돌봄(처치)의 안전성과 전문성, 신체적 안녕감, 책임감 있고 지지적인 직원, 편안한 생활환경, 정신적 안녕감, 의사소통과 정보, 참여와 선호반영 등의 7가지 요인을 요인분석 결과에서 나타난 3개 요인으로 통합, 재구성하였으며, 각 요인에 속한 문항을 검토한 결과 최종 지표는 돌봄(처치)의 안전성 및 전문성, 책임감 있고 지지적인 직원, 참여 및 선호반영으로 명명하였다.
준거타당도 검증을 위하여 단축형 한국어판 사회복지서비스 이용자만족도 척도 (CSI-SF)도구와의 상관관계를 분석한 결과 본 연구에서 개발된 장기요양시설 노인의 서비스 경험 측정지표는 CSI-SF도구와 γ=.714(p<.001)의 높은 상관관계를 나타냈으며, 3개 하부영역은 γ=.475~.633의 상관관계를 나타냈다. 전체 14문항의 신뢰도는 Cronbach’s α 값이 .814였으며, 각 하부 요인별로는 돌봄(처치)의 안전성 및 전문성 요인은 .740, 책임감 있고 지지적인 직원 요인은 .719, 참여와 선호 반영 요인은 .709이었다. 평가자간 신뢰도 검정 결과 일치도 통계는 85~100%, 가중 Kappa값은 .643~1.00(p<.001), ICC는 .791~1.00으로 신뢰할 수 있는 수준이었다.
이상의 과정을 거쳐 3개 하위영역, 14문항으로 구성된 4점 척도의 자가보고 형태의 우리나라 장기요양시설 노인의 서비스 경험 측정지표를 개발하였다. 향후 본 지표를 활용하여 노인의 관점에서 서비스 경험을 측정함으로써 노인을 돌보는 간호 인력에 대한 교육 및 훈련 프로그램 구성에 참고할 수 있을 것이고 궁극적으로 장기요양시설 케어의 질 향상에 기여할 수 있을 것이며, 장기요양시설 노인의 서비스 경험 조사 및 중재 연구에 기초를 제공할 수 있을 것이다.
Backgrounds
Patient experience is the patient’s report of ‘what actually happens’ during the process of service delivery and the patient’s evaluation of his or her experience of care. Good service experience entails active participation of the patients in their own care and the reflection of the...
Backgrounds
Patient experience is the patient’s report of ‘what actually happens’ during the process of service delivery and the patient’s evaluation of his or her experience of care. Good service experience entails active participation of the patients in their own care and the reflection of the patients’ preferences as much as possible. From the 1990s, the trend has shifted from measuring patient satisfaction to measuring patient experience as an indicator of healthcare quality because of its objectiveness in recording of what actually happened. Also, while the existing quality measures mainly reflect the opinions of the family members or proxy physicians, patient experience measures accept the voice of the institutionalized older adult as the golden standard. Patient experience in the long-term care setting is different from that in the hospital because older adults institutionalized in long-term care facilities reside at the place in which they receive their care. Therefore, it is important to measure not only the quality of care but also patients’ quality of life. Consequently, patients’ perspective of care is highly recognized irrespective of their cognitive limitations in measuring the patient experience of older adults in long-term care facilities. The measurement helps, in turn, improve patient experience in receiving care including their day-to-day experience, interpersonal relationships and social environment, which is critical to their treatment.
Moreover, research shows that cognitively impaired, institutionalized older patients are fully able to express not only their care preferences but also their service satisfaction and experience, supporting the validity of the measurement. Therefore, increasingly, long-term care facilities are working to create patient centered culture by utilizing various instruments such as patient experience indexes, satisfaction ratings, and quality of life ratings. In the case of the United States and Canada, the measurement of patient experience is becoming a mandatory procedure.
Until now, indexes that measure older patients’ service experience have been developed extensively in the United States, Canada, and the Netherlands. Researchers have selected the preliminary items in these indexes by reviewing existing measures, conducting phone interviews with experts and having focus group interviews with older adults and their families. They finalize items and scales by cognitive test and pilot survey with older adults and test the indexes for validity and reliability through a pilot study. In developing patient experience measures for long-term care facilities, researchers have often developed an index for family members as a complement to the patient index due to difficulty in response from cognitively impaired patients. In the case of the Netherlands, various measures are developed separately for institutionalized older adults, dementia patients in the psychiatric ward, family members, and patients receiving home care. Survey method was also applied differently by group, for instance, conducting face-to-face interviews with institutionalized older patients, while mail survey with patients in the psychiatric ward.
The subdomain of patient experience differs by how patient experience is defined. There is not yet a single, agreed-upon definition, but the recurring themes and concepts include patient (and their family)’s perspective, continuity of care, integrative characteristics (quality, safety, service), patient (and their family)’s active participation, and patient-centeredness. Depending on the definition, subdomains include autonomy, choice, communication, dignity, quality of basic living condition, cleanliness, information, decision-making in treatment, patient-staff relationship, trustworthiness, integrity, pride and passion, patient participation, prompt responsiveness, and personalized care. In this way, the definition of patient experience and the subdomains differ by country and by institution. Therefore, it is important to develop a measurement that is sensitive to the characteristics of Korean patients in the long-term care facilities.
Research on patient experience in the long-term care setting in Korea is limited to qualitative studies and there are no studies that use a measure that directly reflect the patients’ perspectives in their service experience. One method is to translate a measure developed outside of Korea. However, in such cases, the foreign measures often do not fit well with Korean practice neither reflect cultural and conceptual differences.
Therefore, this study seeks to develop a patient experience index for long-term care residents in the form of a self-reported survey with distinguished range of recipients, tested for reliability and validity. The measurement of patient experience in the long-term care facility can be used for developing education and training programs for caregivers and staff, and ultimately contribute to improving the quality of long term care facilities and provide foundation for research on patient service experience in the long term care setting.
The purpose of this study is to develop a patient experience index for long-term care residents and evaluate its validity and reliability. Specific goals of the study are as follows.
First, explore factors for developing patient experience measure for older patients in long- term care facilities
Second, develop items to be included in the index.
Third, test the validity and reliability of the existing preliminary index and the final index.
Methods and Results
In the development stage, a literature search was conducted along with factor identification using a concept map with 14 older adults in long- term care facilities. The six categories drawn from the concept mapping are a safety of care and treatment, responsible and supportive staff, comfortable living environment, psychological well-being, respect and communication, participation and reflection of preferences. They were combined with the 9 domains of Quality Framework for Responsible Care (QFRC) to finalize 7 factors for this study: safety and professionalism of care, physical well-being, responsible and supportive staff, comfortable living environment, psychological well-being, communication and information, participation and reflection of preferences.
Sixty-four preliminary items were developed through literature review and conceptual mapping. The items were reviewed for content validity by an expert panel of 3 professors of nursing, 2 social workers with over 7 years of experience, 2 nurses with over 3 years of experience, a LTCF director, two professors of geriatric public health, and one PhD student specializing in long term care. The panel selected 47 items as a result of expert’s content validation inventory. Forty-five preliminary items were finalized through conducting cognitive interviews, pilot surveys with older adults in long-term care facilities and review by a Korean linguist.
To test the reliability and validity of the preliminary items, I conducted the survey with 200 older adults in eight long-term care facilities located in Seoul, Gyeonggi, and Chung-nam provinces. With 45 items analyzed, I deleted 17 items that harm the normality and inter-item correlation and validity. As a result, 28 items remained for a factor analysis.
Through two rounds of primary component analysis, a total of 14 items and 3 factors were chosen, leading to total explanation power of 51.89%. I conducted confirmatory factor analysis using Maximum Likelihood Estimation and direct oblimin rotation to test the theoretical model. The model performed favorably with x2=48.558,df=52, level of significance=0.610 (p> .05), RMSEA=0.
The seven factors were selected through experts’ content validation inventory; safety and professionalism of care(treatment), physical well-being, responsible and supportive staff, comfortable living environment, psychological well-being, communication and information, participation and reflection of preferences. They were reconstructed by the results of the factor analysis, finalizing three final factors; safety and professionalism of care, responsible and supportive staff, participation and reflection of preferences.
Correlation with the shortened form of the Korean version of the Client Satisfaction Inventory (CSI-SF) was tested for criterion validity and was found to be highly correlated γ= .714(p< .001), and the three subdomains had a correlation of γ= .475~ .633. Cronbach’s α for the total 14 items was .814 with subcategories showing the following scores: safety and professionalism of care; .740, responsible and supportive staff; .719, participation and reflection of preferences: .709. Inter-rater reliability was statistically significant with a correspondence of 85~100%, Cohen’s weighted kappa 0.643~1.00(p 1) to determine the number of factors. In the process of deciding the number of factors through exploratory factor analysis, there is a need to utilize PA actively in order to improve accuracy and reliability.
Results: This study was carried out to overcome the limitations of using a foreign instrument on the older patients in the long-term care facility and create a patient experience measure that is comprehensive, yet not too long and easy to answer. The final measure includes 3 factors, safety and professionalism of care, responsible and supportive staff, participation and reflection of preferences, and 14 items. The implications of the study’s results are as follows.
First, in the process of reducing the number of factors, items that describe physical environment such as comfortable living environment were deleted and those focused on fundamental concepts of patient experience such as patient-centeredness, responsiveness, and preferences were retained.
Therefore, the measure can be used to measure older adults’ experience and utilize the results in quality improvement initiatives. Second, although the theoretical model was proven to be valid through the χ2 test and RMSEA, further goodness of fit tests are required in various aspects including confirmatory factor analysis. Third, this study secured the reliability of the measure through internal consistency reliability and inter-rater reliability of the finalized measure. However, there was an item with discrepancy between the raters, requiring further education on how to interpret such items.
Conclusion
The patient experience index for long-term care facility developed in this study can be utilized as follows. First, through development of a comprehendible and responsive patient experience index, we will be able to directly hear the patients’ voice and understand the degree of service experience. Second, results of the patient experience measurement can be directly used for quality improvement initiatives. Third, the measurement can be utilized as a quality or program evaluation measure of long- term care facilities.
The limitations of this study are as follows. First, this study was conducted with patients in eight long-term care facilities located in Seoul, Gyeonggi, and Chung-nam provinces, and the characteristics of each facility could have affected the results of the study. Therefore, it is necessary to expand the sample by region, size of the facility, and rating and test for reliability and validity. Second, to test the validity of the patient experience measurement, confirmatory factor analysis is recommended. Lastly, because the measurement developed in the study targeted only those older patients with moderate cognitive impairments, the development of a patient experience measurement for the family member is recommended for those with severe cognitive impairments.
Backgrounds
Patient experience is the patient’s report of ‘what actually happens’ during the process of service delivery and the patient’s evaluation of his or her experience of care. Good service experience entails active participation of the patients in their own care and the reflection of the patients’ preferences as much as possible. From the 1990s, the trend has shifted from measuring patient satisfaction to measuring patient experience as an indicator of healthcare quality because of its objectiveness in recording of what actually happened. Also, while the existing quality measures mainly reflect the opinions of the family members or proxy physicians, patient experience measures accept the voice of the institutionalized older adult as the golden standard. Patient experience in the long-term care setting is different from that in the hospital because older adults institutionalized in long-term care facilities reside at the place in which they receive their care. Therefore, it is important to measure not only the quality of care but also patients’ quality of life. Consequently, patients’ perspective of care is highly recognized irrespective of their cognitive limitations in measuring the patient experience of older adults in long-term care facilities. The measurement helps, in turn, improve patient experience in receiving care including their day-to-day experience, interpersonal relationships and social environment, which is critical to their treatment.
Moreover, research shows that cognitively impaired, institutionalized older patients are fully able to express not only their care preferences but also their service satisfaction and experience, supporting the validity of the measurement. Therefore, increasingly, long-term care facilities are working to create patient centered culture by utilizing various instruments such as patient experience indexes, satisfaction ratings, and quality of life ratings. In the case of the United States and Canada, the measurement of patient experience is becoming a mandatory procedure.
Until now, indexes that measure older patients’ service experience have been developed extensively in the United States, Canada, and the Netherlands. Researchers have selected the preliminary items in these indexes by reviewing existing measures, conducting phone interviews with experts and having focus group interviews with older adults and their families. They finalize items and scales by cognitive test and pilot survey with older adults and test the indexes for validity and reliability through a pilot study. In developing patient experience measures for long-term care facilities, researchers have often developed an index for family members as a complement to the patient index due to difficulty in response from cognitively impaired patients. In the case of the Netherlands, various measures are developed separately for institutionalized older adults, dementia patients in the psychiatric ward, family members, and patients receiving home care. Survey method was also applied differently by group, for instance, conducting face-to-face interviews with institutionalized older patients, while mail survey with patients in the psychiatric ward.
The subdomain of patient experience differs by how patient experience is defined. There is not yet a single, agreed-upon definition, but the recurring themes and concepts include patient (and their family)’s perspective, continuity of care, integrative characteristics (quality, safety, service), patient (and their family)’s active participation, and patient-centeredness. Depending on the definition, subdomains include autonomy, choice, communication, dignity, quality of basic living condition, cleanliness, information, decision-making in treatment, patient-staff relationship, trustworthiness, integrity, pride and passion, patient participation, prompt responsiveness, and personalized care. In this way, the definition of patient experience and the subdomains differ by country and by institution. Therefore, it is important to develop a measurement that is sensitive to the characteristics of Korean patients in the long-term care facilities.
Research on patient experience in the long-term care setting in Korea is limited to qualitative studies and there are no studies that use a measure that directly reflect the patients’ perspectives in their service experience. One method is to translate a measure developed outside of Korea. However, in such cases, the foreign measures often do not fit well with Korean practice neither reflect cultural and conceptual differences.
Therefore, this study seeks to develop a patient experience index for long-term care residents in the form of a self-reported survey with distinguished range of recipients, tested for reliability and validity. The measurement of patient experience in the long-term care facility can be used for developing education and training programs for caregivers and staff, and ultimately contribute to improving the quality of long term care facilities and provide foundation for research on patient service experience in the long term care setting.
The purpose of this study is to develop a patient experience index for long-term care residents and evaluate its validity and reliability. Specific goals of the study are as follows.
First, explore factors for developing patient experience measure for older patients in long- term care facilities
Second, develop items to be included in the index.
Third, test the validity and reliability of the existing preliminary index and the final index.
Methods and Results
In the development stage, a literature search was conducted along with factor identification using a concept map with 14 older adults in long- term care facilities. The six categories drawn from the concept mapping are a safety of care and treatment, responsible and supportive staff, comfortable living environment, psychological well-being, respect and communication, participation and reflection of preferences. They were combined with the 9 domains of Quality Framework for Responsible Care (QFRC) to finalize 7 factors for this study: safety and professionalism of care, physical well-being, responsible and supportive staff, comfortable living environment, psychological well-being, communication and information, participation and reflection of preferences.
Sixty-four preliminary items were developed through literature review and conceptual mapping. The items were reviewed for content validity by an expert panel of 3 professors of nursing, 2 social workers with over 7 years of experience, 2 nurses with over 3 years of experience, a LTCF director, two professors of geriatric public health, and one PhD student specializing in long term care. The panel selected 47 items as a result of expert’s content validation inventory. Forty-five preliminary items were finalized through conducting cognitive interviews, pilot surveys with older adults in long-term care facilities and review by a Korean linguist.
To test the reliability and validity of the preliminary items, I conducted the survey with 200 older adults in eight long-term care facilities located in Seoul, Gyeonggi, and Chung-nam provinces. With 45 items analyzed, I deleted 17 items that harm the normality and inter-item correlation and validity. As a result, 28 items remained for a factor analysis.
Through two rounds of primary component analysis, a total of 14 items and 3 factors were chosen, leading to total explanation power of 51.89%. I conducted confirmatory factor analysis using Maximum Likelihood Estimation and direct oblimin rotation to test the theoretical model. The model performed favorably with x2=48.558,df=52, level of significance=0.610 (p> .05), RMSEA=0.
The seven factors were selected through experts’ content validation inventory; safety and professionalism of care(treatment), physical well-being, responsible and supportive staff, comfortable living environment, psychological well-being, communication and information, participation and reflection of preferences. They were reconstructed by the results of the factor analysis, finalizing three final factors; safety and professionalism of care, responsible and supportive staff, participation and reflection of preferences.
Correlation with the shortened form of the Korean version of the Client Satisfaction Inventory (CSI-SF) was tested for criterion validity and was found to be highly correlated γ= .714(p< .001), and the three subdomains had a correlation of γ= .475~ .633. Cronbach’s α for the total 14 items was .814 with subcategories showing the following scores: safety and professionalism of care; .740, responsible and supportive staff; .719, participation and reflection of preferences: .709. Inter-rater reliability was statistically significant with a correspondence of 85~100%, Cohen’s weighted kappa 0.643~1.00(p 1) to determine the number of factors. In the process of deciding the number of factors through exploratory factor analysis, there is a need to utilize PA actively in order to improve accuracy and reliability.
Results: This study was carried out to overcome the limitations of using a foreign instrument on the older patients in the long-term care facility and create a patient experience measure that is comprehensive, yet not too long and easy to answer. The final measure includes 3 factors, safety and professionalism of care, responsible and supportive staff, participation and reflection of preferences, and 14 items. The implications of the study’s results are as follows.
First, in the process of reducing the number of factors, items that describe physical environment such as comfortable living environment were deleted and those focused on fundamental concepts of patient experience such as patient-centeredness, responsiveness, and preferences were retained.
Therefore, the measure can be used to measure older adults’ experience and utilize the results in quality improvement initiatives. Second, although the theoretical model was proven to be valid through the χ2 test and RMSEA, further goodness of fit tests are required in various aspects including confirmatory factor analysis. Third, this study secured the reliability of the measure through internal consistency reliability and inter-rater reliability of the finalized measure. However, there was an item with discrepancy between the raters, requiring further education on how to interpret such items.
Conclusion
The patient experience index for long-term care facility developed in this study can be utilized as follows. First, through development of a comprehendible and responsive patient experience index, we will be able to directly hear the patients’ voice and understand the degree of service experience. Second, results of the patient experience measurement can be directly used for quality improvement initiatives. Third, the measurement can be utilized as a quality or program evaluation measure of long- term care facilities.
The limitations of this study are as follows. First, this study was conducted with patients in eight long-term care facilities located in Seoul, Gyeonggi, and Chung-nam provinces, and the characteristics of each facility could have affected the results of the study. Therefore, it is necessary to expand the sample by region, size of the facility, and rating and test for reliability and validity. Second, to test the validity of the patient experience measurement, confirmatory factor analysis is recommended. Lastly, because the measurement developed in the study targeted only those older patients with moderate cognitive impairments, the development of a patient experience measurement for the family member is recommended for those with severe cognitive impairments.
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