Construction and Validation of a Quality Evaluation Scale for Integrated Medical and Care Services in Elderly Care Institutions in Xiamen Region

doi:10.21203/rs.3.rs-4147511/v1

Objective

This study aims to construct and validate a scale for evaluating the quality of integrated medical and care services in elderly care institutions in Xiamen region.

Methods

A preliminary scale was constructed through literature review, expert selection and evaluation, and pre-survey. From May to November 2022, a proportional sample of elderly individuals was surveyed in seven care institutions across four districts in Xiamen city (Siming, Huli, Jimei, and Tong'an). Statistical methods, including critical ratio analysis, reliability and validity analysis, difference testing, and correlation analysis, were used to refine the scale items and assess its reliability and validity.

Results

The final scale comprised six dimensions: Health Education (10 items), Medical and Basic Nursing Care (14 items), Rehabilitation Services (7 items), Psychological/Spiritual Support Services (5 items), Medical-Related Safety Protection (6 items), and Others (6 items). The Cronbach's α coefficient was 0.991, and the α coefficients for the six dimensions were 0.974, 0.942, 0.951, 0.860, 0.901, and 0.930, respectively. Exploratory factor analysis demonstrated good validity (KMO = 0.942, χ2 = 13957.791, P < 0.001).

Conclusion

The constructed scale for evaluating the quality of integrated medical and care services in elderly care institutions in Xiamen demonstrated satisfactory reliability and validity. It can serve as a practical tool for evaluating the quality of such services and contribute to the standardization and professionalization of integrated medical and care services in the region.

Elderly Care Institutions

Integrated Medical and Care Services

Quality Evaluation

Reliability

Validity

With the exacerbation of population aging, the weakening of family care functions, and the trends of smaller and empty-nest families, the demand for social elderly care services has increased significantly^[1–4]. Elderly care institutions have become a primary care model that aligns with the characteristics and needs of elderly individuals in China^[5–6]. The concept of "integration of medical care and elderly care" was first introduced in the 2013 "Opinions on Accelerating the Development of the Elderly Service Industry" by the State Council. Subsequently, national development plans emphasized the development of the elderly service industry, establishment of cooperation mechanisms between medical institutions and elderly care institutions, promotion of integrated medical and care services, and the advancement of healthy aging^[7–9].

Integrated medical and care services aim to integrate medical and care resources to meet the dual needs of elderly individuals for care and medical services, ensuring that they are both well-cared-for and receive necessary medical attention^[10–12]. Therefore, elderly care institutions are not merely providers of basic daily life services for elderly individuals but play a crucial role in prioritizing their health and psychological needs within the integrated medical and care model^{[10, 12]}. To advance the standardized, institutionalized, regulated, and professional development of integrated medical and care services in elderly care institutions, it is essential to establish a comprehensive quality evaluation system.

Currently, there is no comprehensive quality evaluation standard for integrated medical and care services in China, and the standardization process for integrated medical and care services has been slow^[7–8]. Therefore, there is an urgent need to develop a practical and scientifically applicable quality evaluation scale for elderly care institutions in the Xiamen region under the integrated medical and care model. This research aims to construct such a scale, validate its reliability and validity, and provide a tool for evaluating the status and development of elderly care institutions in the region, identifying existing issues, and proposing effective measures to enhance the level of medical services and improve the quality of life for elderly individuals.

1. Study Subjects and Methods

1.1 Study Subjects

The study focused on elderly care institutions in the Xiamen region, and data were collected through a structured electronic survey questionnaire. From May to November 2022, seven care institutions were proportionally selected from four districts in Xiamen (Siming, Huli, Jimei, and Tong'an). Elderly individuals residing in these institutions were selected in proportion, and a total of 219 electronic questionnaires were collected. Of these, 201 were deemed valid, resulting in an effective response rate of 91.8%.

1.2 Study Methods

1.2.1 Scale Construction

1.2.1.1 Scale Content

A preliminary scale was developed through a literature review, summarizing factors influencing the quality evaluation of integrated medical and care services in elderly care institutions in the Xiamen region^[13–20]. Items were extracted from internationally recognized satisfaction scales^[13–14], resulting in the formulation of a comprehensive scale comprising 68 items across 12 categories (12 items for basic information on the subjects and 56 items for the evaluation of integrated medical and care services across six dimensions).

1.2.1.2 Scoring of the Scale

The Likert 5-point scale was employed for scoring, ranging from "Strongly Disagree" (1 point) to "Strongly Agree" (5 points). The total score for the scale was calculated as the sum of scores for all items, with higher scores indicating higher satisfaction with the quality of integrated medical and care services in the respective elderly care institution.

1.2.1.3 Item Selection

Critical ratio analysis and correlation analysis were employed for item selection.

1.2.1.4 Scale Reliability Testing

Cronbach's α coefficient was calculated to assess the internal consistency of the scale.

1.2.1.5 Scale Validity Testing

Structural validity was assessed through exploratory factor analysis using Bartlett's sphericity test, and the Kaiser-Meyer-Olkin (KMO) test was used to evaluate the sampling adequacy.

1.2.2 Statistical Methods

Data were entered using EpiData 3.1 and analyzed using SPSS 26.0. Descriptive statistics, critical ratio analysis, reliability and validity analysis, difference testing, and correlation analysis were performed. A significance level of P < 0.05 was considered statistically significant.

2. Results

2.1 Frequency Analysis of Demographic Variables of Survey Subjects (Table 1)

Table 1

Frequency analysis of demographic variables
Variable	Option	Frequency	Percentage	Mean	SD
Gender	Male	109	54.23%	1.46	0.50
Gender	Female	92	45.77%	1.46	0.50
Age	60 ~ 70	33	16.42%	2.83	1.06
	70 ~ 80	33	16.42%
	80 ~ 90	71	35.32%
	Above 90	64	31.84%
Regular medical checkups	No	92	45.77%	1.54	0.50
Regular medical checkups	No	109	54.23%	1.54	0.50
Educational level	Illiteracy	29	14.43%	3.04	1.39
	Elementary School	57	28.36%
	Middle school	36	17.91%
	High School	35	17.41%
	University and above	44	21.89%

The analysis of demographic variables provides insights into the distribution of the surveyed population, with mean values representing central tendencies and standard deviations reflecting variability. The frequency analysis results indicate that the distribution generally meets the requirements of the sampling survey.

2.2 Analysis and Selection of Scale Items

2.2.1 Critical Ratio Analysis

The results revealed that item 27 ("Matters related to drug use and distribution") had a CR value of 2.499, and items 31 ("Fall prevention and handling plan and process for the elderly") and 46 ("System and workflow for psychological counseling services") had CR values of 0.188 and 0.463, respectively (P > 0.05). These three items were deemed nonsignificant and were subsequently deleted.

2.2.2 Correlation Analysis

Correlation analysis showed significant positive correlations between various variables at the 99% significance level. For example, the correlation coefficient between Medical and Basic Nursing Care and Health Education was 0.722, indicating a positive correlation. Similar positive correlations were observed across other dimensions, supporting the rationality of the scale structure. (Table 2)

Table 2

Correlation analysis between dimensions
Variable	Relevance	Health promotion	Medical and primary care	Rehabilitation services	Psychological/psychiatric support services	Health-related safety and security	Other
Health promotion	Pearson Correlation	1
Medical and primary care	Pearson Correlation	.722^**	1
Rehabilitation services	Pearson Correlation	.765^**	.788^**	1
Psychological/psychiatric support services	Pearson Correlation	.697^**	.721^**	.794^**	1
Health-related safety and security	Pearson Correlation	.658^**	.730^**	.723^**	.687^**	1
Other	Pearson Correlation	.670^**	.704^**	.763^**	.698^**	.804^**	1
**. At the 0.01 level (two-tailed), the correlation was significant.

2.2.3 Difference Test

According to the results of the independent samples t-test, it can be seen that the difference situation of each survey dimension on gender, the p-value is greater than 0.05, indicating that there is no significant difference between the dimensions on gender (Table 3).

Table 3

Differences between dimensions in terms of gender
Variable	Gender	Number of cases	Mean	SD	t	P
Health promotion	Male	109	30.07	10.407	-0.768	0.444
Health promotion	Female	92	31.32	12.529
Medical and primary care	Male	109	38.57	12.147	0.255	0.799
Medical and primary care	Female	92	38.11	13.381
Rehabilitation services	Male	109	22.16	7.784	-0.565	0.573
Rehabilitation services	Female	92	22.79	8.176
Psychological/psychiatric support services	Male	109	16.64	5.510	-1.197	0.233
Psychological/psychiatric support services	Female	92	17.62	6.062
Health-related safety and security	Male	109	17.66	5.738	0.806	0.421
Health-related safety and security	Female	92	17.00	5.842
Other	Male	109	18.15	5.717	1.348	0.179
Other	Female	92	17.07	5.610

According to the results of one-way ANOVA, it can be seen that among the six dimensions of the satisfaction survey, there is a difference only on psychological/spiritual support services (P < 0.05) (Table 4).

Table 4

Results of analysis of differences between dimensions on age
Variable	Options	Number of cases	Mean	SD	F	P	Multiple comparisons
Health promotion	60 ~ 70	33	30.73	11.703	1.591	0.193	/
	70 ~ 80	33	26.82	12.526
	80 ~ 90	71	31.93	11.417
	90 +	64	31.14	10.476
Medical and primary care	60 ~ 70	33	39.09	11.991	2.488	0.062	/
	70 ~ 80	33	33.30	13.612
	80 ~ 90	71	40.46	13.274
	90 +	64	38.25	11.407
Rehabilitation services	60 ~ 70	33	22.79	8.104	1.841	0.141	/
	70 ~ 80	33	19.64	8.591
	80 ~ 90	71	23.51	8.206
	90 +	64	22.55	7.044
Psychological/psychiatric support services	60 ~ 70	33	16.48	5.568	2.733	0.045	60 ~ 70 > 70 ~ 80 70 ~ 80 < 80 ~ 90 80 ~ 90 > 90 + 90 + > 60 ~ 70
	70 ~ 80	33	15.06	5.798
	80 ~ 90	71	18.38	6.495
	90 +	64	17.02	4.685
Health-related safety and security	60 ~ 70	33	17.00	5.426	1.438	0.233	/
	70 ~ 80	33	15.67	6.268
	80 ~ 90	71	18.13	5.904
	90 +	64	17.56	5.494
90 +	90 +	33	17.48	6.104	1.430	0.235	/
	90 +	33	16.00	6.108
	90 +	71	17.73	5.702
	90 +	64	18.50	5.121
	Total	201	17.65	5.680

According to the results of the independent samples t-test, it can be seen that the p-value is less than 0.05 in the case of differences between the survey dimensions on the status of regular medical checkups, indicating that there is a significant difference in the status of regular medical checkups in all dimensions (Table 5).

Table 5

Differences in regular medical checkups by dimension
Variable	Options	Number of cases	Mean	SD	t	P
Health promotion	Yes	92	28.25	12.687	-2.716	0.007
Health promotion	No	109	32.66	9.832
Medical and primary care	Yes	92	35.67	13.844	-2.752	0.007
Medical and primary care	No	109	40.62	11.212
Rehabilitation services	Yes	92	20.22	8.206	-3.772	0.000
Rehabilitation services	No	109	24.33	7.250
Psychological/psychiatric support services	Yes	92	16.16	6.346	-2.108	0.036
Psychological/psychiatric support services	No	109	17.87	5.146
Health-related safety and security	Yes	92	15.99	6.162	-3.108	0.002
Health-related safety and security	No	109	18.51	5.192
Other	Yes	92	16.03	6.126	-3.767	0.000
Other	No	109	19.02	4.899

According to the results of One-way ANOVA, it can be seen that among the six dimensions of the satisfaction survey, there is a difference only on psychological/spiritual support services (P < 0.05) (Table 6).

Table 6

Results of the analysis of variance of each dimension in terms of educational attainment
Variable	Options	Number of cases	Mean	SD	F	P	Multiple comparisons
Health promotion	Illiteracy	29	30.59	10.517	0.840	0.501	/
	Elementary school	57	28.53	10.126
	Middle School	36	31.06	11.779
	High School	35	32.71	12.595
	University and above	44	31.43	12.324
Medical and primary care	Illiteracy	29	36.76	12.936	1.155	0.332	/
	Elementary school	57	37.63	12.150
	Middle School	36	36.39	12.051
	High School	35	42.06	14.002
	University and above	44	39.02	12.571
Rehabilitation services	Illiteracy	29	20.93	7.896	1.248	0.292	/
	Elementary school	57	21.47	7.134
	Middle School	36	21.89	7.355
	High School	35	24.09	8.361
	University and above	44	23.86	8.980
Psychological/psychiatric support services	Illiteracy	29	15.03	4.822	3.559	0.008	Illiteracy < Elementary School Elementary School < Junior High School Middle School < High School High School > University and above University and above > Illiteracy
	Elementary school	57	15.72	5.143
	Middle School	36	17.47	5.911
	High School	35	19.26	5.596
	University and above	44	18.18	6.467
Health-related safety and security	Illiteracy	29	16.83	5.339	1.287	0.276	/
	Elementary school	57	17.86	5.495
	Middle School	36	16.19	6.641
	High School	35	18.91	5.746
	University and above	44	16.77	5.619
Other	Illiteracy	29	16.93	5.725	0.491	0.742	/
	Elementary school	57	17.84	5.304
	Middle School	36	16.89	6.260
	High School	35	18.49	6.021
	University and above	44	17.84	5.477
	Total	201	17.65	5.680

2.3 Reliability and Validity Analysis

2.3.1 Reliability Analysis

The Cronbach's α coefficient for the scale was 0.991, indicating high internal consistency. Moreover, the α coefficients for the six dimensions ranged from 0.860 to 0.974, demonstrating good reliability. (Table 7).

Table 7

Overall reliability analysis
Cronbach's α	Cronbach's α based on standardized terms	Item
0.991	0.991	48.000

2.3.2 Validity Analysis

Exploratory factor analysis yielded a KMO value of 0.942 and a χ2 value of 13957.791 (P < 0.001), suggesting that the scale had good structural validity. (Table 8).

Table 8

KMO and Bartlett's test
Kaiser-Meyer-Olkin metric of sampling adequacy		0.942
Bartlett's test of sphericity	Approximate chi-square	13957.791
	df	1275
	Sig.	0.000

The present study aimed to construct and validate a quality evaluation scale for integrated medical and care services in elderly care institutions in the Xiamen region. Through literature review, expert consultation, and empirical investigation, a comprehensive scale comprising six dimensions and 48 items was developed. The scale demonstrated high reliability and validity, indicating its potential as a practical tool for evaluating the quality of integrated medical and care services in elderly care institutions.

The scale construction process involved rigorous item selection and validation procedures, including critical ratio analysis, reliability analysis, and validity analysis. Through these procedures, the final scale was refined to ensure its accuracy, reliability, and validity in assessing the quality of integrated medical and care services.

The findings of this study contribute to the development of quality evaluation systems for elderly care institutions, particularly in the context of integrated medical and care services. By providing a standardized tool for assessing service quality, policymakers and healthcare professionals can identify areas for improvement and implement targeted interventions to enhance the quality of care provided to elderly individuals.

Limitations of the study include the sample size and geographical scope, which may limit the generalizability of the findings. Future research could explore the applicability of the scale in other regions and settings to further validate its reliability and validity.

The quality evaluation scale developed in this study represents a significant step toward standardizing and improving the quality of integrated medical and care services in elderly care institutions in the Xiamen region. By providing a comprehensive framework for assessing service quality, the scale offers valuable insights into the strengths and weaknesses of existing care practices and informs strategies for enhancing the quality of care provided to elderly individuals. Further research is needed to validate the scale in other contexts and settings to ensure its reliability and validity across diverse populations.

Acknowledgments

We are grateful to all the subjects for their participation.

Author Contributions

The study concept and design were framed by JC. WL, YY and QS collected data. SH and WL conducted the statistical data analysis and drafted the manuscript. JC, WL, YY and QS contributed to discussion and revision. All authors read and approved the final manuscript.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding Information

JC was funded by Xiamen City Association for Science and Technology Key Research Topics Project (No. KX20222003).

Ethical approval and consent to participate

The study received approval and was carried out in accordance with the approved guidelines of the ethics committee of the First Affiliated Hospital of Xiamen Medical University

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No competing interests reported.

Construction and Validation of a Quality Evaluation Scale for Integrated Medical and Care Services in Elderly Care Institutions in Xiamen Region

Status:

Version 1

Abstract

Objective

Methods

Results

Conclusion

Introduction

Materials and Methods

1. Study Subjects and Methods

1.1 Study Subjects

1.2 Study Methods

1.2.1 Scale Construction

1.2.1.2 Scoring of the Scale

1.2.1.3 Item Selection

1.2.1.4 Scale Reliability Testing

1.2.1.5 Scale Validity Testing

1.2.2 Statistical Methods

Results and discussion

2. Results

2.1 Frequency Analysis of Demographic Variables of Survey Subjects (Table 1)

2.2 Analysis and Selection of Scale Items

2.2.1 Critical Ratio Analysis

2.2.2 Correlation Analysis

2.2.3 Difference Test

2.3 Reliability and Validity Analysis

2.3.1 Reliability Analysis

2.3.2 Validity Analysis

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1