基于循证及德尔菲法构建慢性心力衰竭患者容量管理方案

Construction of capacity management program for patients with chronic heart failure based on evidence-based and Delphi method

目的基于循证及德尔菲法构建慢性心力衰竭患者容量管理方案。方法整体研究时间为2022年4—9月。在证据总结、半结构式访谈的基础上经过小组讨论拟订慢性心力衰竭患者容量管理方案初稿。采用目的抽样法,于2022年6—9月选取上海市16名心内科医疗专家、心内科护理专家、营养专家进行2轮专家函询,制定慢性心力衰竭患者容量管理方案。专家积极系数用问卷的有效回收率表示;专家权威程度采用权威系数(Cr)表示;专家意见集中程度采用重要性赋值均数、满分率表示;专家意见协调程度采用肯德尔协调系数(Kendall’’sW)、变异系数表示。结果2轮专家函询的问卷有效回收率均为100.0%(16/16),专家Cr分别为0.908、0.917。第2轮函询一、二级条目的Kendall’’sW值分别为0.354、0.367(P<0.05)。第2轮函询各级条目的重要性赋值均数为3.81~5.00分,满分率为25.0%~100.0%,变异系数为0~0.24。最终构建的慢性心力衰竭患者容量管理方案包括6个一级条目,36个二级条目。结论针对慢性心力衰竭患者的容量管理方案构建过程科学可靠,内容全面具体,可为临床人员以及慢性心力衰竭患者提供全面的容量管理方案。

Objective To construct a capacity management program for patients with chronic heart failure based on evidence-based and Delphi method.Methods The overall research period was from April to September 2022.Based on evidence summary and semi-structured interviews,a preliminary draft of capacity management program for patients with chronic heart failure was developed through group discussion.From June to September 2022,purposive sampling was used to select 16 cardiology medical experts,cardiology nursing experts,and nutrition experts in Shanghai for two rounds of expert consultation to develop a capacity management program for chronic heart failure patients.The positive coefficient of experts was expressed by the effective recovery rate of the questionnaire,and the authority level of experts was represented by the authority coefficient(Cr),and the concentration of expert opinions was expressed by the mean of importance assignment and the full score rate,and the degree of coordination of expert opinions was represented by Kendall's W and coefficient of variation.Results The effective response rates of the two rounds of expert consultation questionnaires were 100.0%(16/16),with expert Cr of 0.908 and 0.917,respectively.The Kendall's W values for the first-level and second-level items in the second round of consultation were 0.354 and 0.367,respectively(P<0.05).In the second round of consultation,the mean of item importance assignment at all levels was 3.81 to 5.00,with full score rates of 25.0%to 100.0%and coefficients of variation of 0 to 0.24.The final capacity management program for chronic heart failure patients included 6 first-level items and 36 second-level items.Conclusions The process of constructing a capacity management program for patients with chronic heart failure is scientific and reliable,with comprehensive and specific content.It can provide comprehensive capacity management programs for clinical personnel and patients with chronic heart failure.