Figure 1
Theoretical presupposition model of dimensions and elements of vertical professional integration evaluation.
Table 1
Dimensions, elements, connotation and corresponding items of vertical professional integration.
| DIMENSIONS | ELEMENTS AND CONNOTATIONS | ITEMS AND CODES |
|---|---|---|
| Division of labor and cooperation between professions | Inter-professional coordination mechanism: whether an effective inter-professional communication and coordination mechanism is established, with specialized departments or personnel organizing and coordinating multidisciplinary consultations. | 7\9\10 |
| Inter-professional collaboration mode: whether an inter-professional collaboration mode is adopted, such as the establishment of inter-professional service team, specialist alliance, etc. | 2\3 | |
| The degree of inter-professional collaboration: How close is inter-professional coordination | 1\4\5\6\8 | |
| Incentive and constraint mechanism | Incentive mechanism of inter-professional collaboration: whether relevant indicators are included into the performance appraisal, and whether the appraisal results are linked to job recruitment, individual salary, career development, etc. | 12\13\14 |
| Constraint mechanism of inter-professional collaboration: whether there are oversight and accountability mechanisms for inter-professional collaboration. | 11 | |
| Interprofessional service norms and standards | Norms and standards for inter-professional collaboration: Whether relevant norms and standards are established. | 16\17\18\19 |
| Compatibility of values and cultures between professions | Shared value of “People-centered” concept among professionals: Whether different professionals recognize “People-centered” values. | 15\22\23 |
| Inter-professional trust: The degree of trust between different specialties. | 20\21 |
Table 2
Structure validity test of common factors and corresponding items.
| COMMON FACTORS | ITEMS | COMMON DEGREE | FACTOR LOAD | ITEM SCORE AND TOTAL SCORE COEFFICIENT |
|---|---|---|---|---|
| F1 | 18 | 0.778 | 0.807 | 0.206 |
| 20 | 0.778 | 0.832 | 0.244 | |
| 21 | 0.803 | 0.819 | 0.216 | |
| 22 | 0.825 | 0.856 | 0.240 | |
| 23 | 0.793 | 0.824 | 0.245 | |
| F2 | 6 | 0.715 | 0.769 | 0.239 |
| 7 | 0.728 | 0.754 | 0.230 | |
| 9 | 0.834 | 0.811 | 0.249 | |
| 10 | 0.695 | 0.747 | 0.254 | |
| F3 | 12 | 0.707 | 0.765 | 0.264 |
| 13 | 0.765 | 0.868 | 0.339 | |
| 14 | 0.778 | 0.879 | 0.351 | |
| 15 | 0.535 | 0.672 | 0.272 | |
| F4 | 2 | 0.671 | 0.452 | 0.789 |
| 3 | 0.654 | 0.719 | 0.388 | |
| F5 | 16 | 0.820 | 0.533 | 0.786 |
| 17 | 0.804 | 0.814 | 0.560 |
Table 3
Model fitting index.
| RMSEA | CFI | NFI | NNFI | |
|---|---|---|---|---|
| Standard | <0.10 | >0.9 | >0.9 | >0.9 |
| The initial model (M0) | 0.098 | 0.905 | 0.883 | 0.881 |
| The revised model (M1) | 0.097 | 0.922 | 0.903 | 0.9 |
Table 4
Evaluation dimensions, elements, and their corresponding items.
| COMMON FACTORS | DIMENSIONS | ELEMENTS | ITEMS |
|---|---|---|---|
| F1 | Inter-professional service norms and standards | Specifications and standards for Inter-professional collaboration | 18. Do you think the current service specifications and standards for inter-professional collaboration are reasonable? |
| Compatibility of values and cultures between professions | Degree of trust between different specialties. | 20. Do you think inter-professional collaboration is helpful to improve the quality of medical services in county-level hospitals? | |
| 21. Do you think inter-professional collaboration is helpful to improve the quality of medical services in primary medical institutions? | |||
| Sharing “People-centered” values among professionals | 22. Do you think inter-professional collaboration is helpful in providing integrated and continuous medical and health services to patients? | ||
| 23. Do you think it is necessary to carry out inter-professional collaboration? | |||
| F2 | Division of labor and cooperation between professions | Closeness of inter-professional collaboration. | 6. Do you refer to diagnoses and treatment plans of other medical institutions in the medical community? |
| Inter-professional coordination mechanism | 7. Is specific coordination available for you to have inter-professional collaboration with other doctors? | ||
| 9. Have you ever conducted collaboration with doctors from other medical institutions in the medical community on the medical information platform? | |||
| 10. Have you ever obtained patient’s previous diagnosis and treatment information from the medical information platform? | |||
| F3 | Incentive and constraint mechanism | Incentive mechanism for inter-professional collaboration | 12. Does engagement in inter-professional collaboration add up to your performance appraisal score? |
| 13. Does engagement in inter-professional collaboration increase your income? | |||
| 14. Does engagement in inter-professional collaboration boost your career development such as professional title promotion? | |||
| Compatibility of values and cultures between professions | Sharing “People-centered” values among professionals | 15. Does engagement in inter-professional collaboration have a positive impact on trust between you and your patients? | |
| F4 | Division of labor and cooperation between professions | Inter-professional coordination mechanism | 2. What professional collaborations have you participated in the medical community? |
| 3. What information do you have to contact doctors in other medical institutions within the community? |
Figure 2
Verified theoretical model of the evaluation dimensions and elements of vertical inter-professional collaboration of healthcare system.
Table 5
Verified evaluation dimensions, elements and corresponding items of vertical professional integration in healthcare system.
| COMMON FACTORS | DIMENSIONS | ELEMENTS | ITEMS AND CODES |
|---|---|---|---|
| F1 | Value compatibility and trust Definition: The alignment of health-related values, cultural norms, and behavioral expectations across vertically tiered (e.g., primary vs. tertiary care) and horizontally distinct (e.g., physicians vs. nurses) healthcare providers. | Value compatibility | 18. Do you think the current service specifications and standards for professional collaboration are reasonable? |
| 22. Do you think professional collaboration is helpful in providing integrated and continuous medical and health services to patients? | |||
| 23. How do you see the need for professional collaboration? | |||
| Trust | 20. Do you think professional collaboration is helpful to improve the quality of medical services in county-level hospitals? | ||
| 21. Do you think professional collaboration is helpful to improve the quality of medical services in primary medical institutions? | |||
| F2 | Division of professional labor and cooperation Definition: Systems governing the bidirectional flow of clinical/administrative information and procedural safeguards to enable cross-level, cross-specialty collaboration. | Information system | 6. Do you refer to diagnoses and treatment plans of other medical institutions in the medical community? |
| 9. Have you collaborated with doctors from other medical institutions in the medical community on the medical information platform? | |||
| 10. Have you ever obtained the patient’s previous diagnosis and treatment information from the medical information platform? | |||
| Organization safeguards | 7. Is there someone to coordinate your collaboration with your collaborating doctors? | ||
| F3 | Incentive and constraint mechanism Definition: Policy-driven tools (financial/non-financial) designed to promote or deter specific collaborative behaviors among healthcare professionals. | Material incentive and constraint mechanism | 12. Does engagement in inter-professional collaboration add up to your performance appraisal score? |
| 13. Does engagement in inter-professional collaboration increase your performance earnings? | |||
| 14. Does engagement in inter-professional collaboration boost your career development such as professional title promotion? | |||
| Non-material incentive and constraint mechanism | 15. Does engagement in inter-professional collaboration have a positive impact on trust between you and your patients? | ||
| F4 | Structure and strength of cooperative relationship Definition: The topology (e.g., centrality, density) and resilience of social/professional networks linking multi-level, multi-disciplinary providers. | Structure of cooperative relationship | 2. What professional collaborations have you participated in the medical community? |
| Strength of cooperative relationship | 3. What information do you have to contact doctors in other medical institutions within the community? |