Abstract
BackgroundThe original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems.MethodsThe translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach’s alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit.ResultsDuring the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach’s alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis.ConclusionsThe results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.
Highlights
The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care
These results showed that the RMIC-MT provider version is a valuable psychometric tool for evaluating integrated care initiatives in various countries
The structure and scoring of the original RMIC-MT care provider version Based on the dimensions in the Rainbow Model, The original RMIC-MT care provider version consists of 48 items grouped into eight dimensions: (1) Personcenteredness (5 items), (2) Community-centeredness (4 items), (3) Clinical Integration (7 items), (4) Professional Integration (7 items), (5) Organizational Integration (4 items), (6) System Integration (3 items), (7) Technical competence (10 items), (8) Cultural competence (8 items)
Summary
The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. Health systems in some low- and middle-income countries, as well as in most high-income countries, face the challenges of aging populations and rising chronic disease prevalence [1, 2]. These growing challenges call for more integrated approaches instead of the current single-disease and acute-care-focused health care systems. While the aims are promising, integrated care remains a complex health intervention involving multiple levels of organizations with multiple care providers, multiple interventions, and multiple contextual factors that can influence processes and outcomes of care delivery [8, 9]. Measuring care providers’ experience and behavior in a consistent way is critical for evaluation of the implementation of integration interventions and advancement of the success of health care integration [10], since multiple care providers are the final driver of providing integrated care
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