Abstract: Background　At present，integrated medical and nursing institutions are faced with serious problems such as service supply-demand mismatch and idle resources caused by the emphasis on facility construction and ignorance of service needs.Since there still lacks a unified national instrument assessing institutional elderly service demands in China，and available instruments are found to be with properties of incompleteness，strong locality，monotonous factors，and poor applicability，it is imperative to compile a questionnaire which can comprehensively and accurately assess the service demands of older people in integrated medical and nursing institutions.Objective　To compile a questionnaire with favorable validity and reliability that can comprehensively assess the service demand of older people in integrated medical and nursing institutions.Methods　The initial item pool of the questionnaire was developed on the basis of policy literature review and semi-structural interview.Then the items were screened using the boundary value method according to the results of two rounds of consultation using an Email-based Delphi approach with a convenience sample of 23 experts from 5 regions（Beijing，Shanghai，Jiangsu，Sichuan and Guizhou） during November 2018 to January 2019 after experts' positive and authoritative coefficients and Kendall's W were determined as eligible.Then the Questionnaire on Kano Model-based Service Needs among Older People in Integrated Medical and Nursing Institutions was developed using the screened items，with positive and reverse service quality attributes classified according to the Kano model，and its validity and reliability were tested from February to June 2019 in a convenience sample of older people from 27 elderly care institutions in 4 cities （Chengdu，Panzhihua，Luzhou and Zigong） of Sichuan province.Results　The experts' positive and authoritative coefficients and Kendall's W for the first round of consultation were 87.0%，0.910，and 0.309，respectively，and for the second round of consultation were 95.0%，0.927，and 0.349，respectively.After the consultation，the questionnaire was developed，including 5 first-level items （daily care，medical care，health care，psychological and social support，environmental security），and 64 second-level items.The survey for testing its validity and reliability was conducted in 800 participants，received a response rate of 96.6%（773/800）.The overall demand priority of the services stratified by the Kano model was:environmental security>daily care>medical care>psychological and social support>health care.The Cronbach's α coefficient of positive questions was 0.906，and Cronbach's α coefficients for the 5 dimensions，daily care，medical care，health care，psychological and social support，environmental security，were 0.921，0.901，0.937，0.873，and 0.902，respectively.The Cronbach's α coefficient of reverse questions was 0.898，with Cronbach's α coefficients for the above-mentioned 5 dimensions of 0.926，0.881，0.912，0.862，0.894，respectively.The questionnaire had an inter-rater reliability of 0.859，and item-level content validity indices（CVI） ranging from 0.833 to 1.000，S-CVI （S-CVI/UA） of 0.859，and average S-CVI（S-CVI/Ave） of 0.977.Conclusion　Our questionnaire may serve as an instrument assessing the service needs of older people in integrated medical and nursing institutions for its favorable validity and reliability.

Key words: Nursing institutions for the elderly, Aged, Service needs, Combination of medical treatment and provision for the elderly, Questionnaire compilation, Validity, Reliability

摘要： 背景　目前医养结合型养老机构重机构设施建设、轻服务，导致服务供需错位、资源闲置等问题突出。由于我国还未有统一标准的机构老年人服务需求评估工具，现有评估工具呈现出评价不全面、地区性明显、维度单一、适用性不强等问题。因此，编制能够全面、精准评估养老机构老年人服务需求的评估问卷迫在眉睫。目的　编制具有良好信效度且能全面评价医养结合型养老机构老年人服务需求的调查问卷。方法　在政策文献分析、半结构式访谈的基础上初步确立问卷条目池。于2018年11月—2019年1月，采用便利抽样法选取来自北京、上海、江苏、四川、贵州5个省市共23名专家作为函询对象，进行2轮德尔菲专家函询，统计分析专家的积极系数、权威程度、肯德尔和谐系数（Kendall W），采用界值法进行条目的筛选。以专家函询确立的问卷条目为基础，编制医养结合型养老机构老年人服务需求Kano属性问卷，通过Kano模型特定的正向和反向问题设置，实现服务需求属性的划分。于2019年2—6月，采用便利抽样法选取四川省成都市、攀枝花市、泸州市、自贡市共27家养老机构内老年人作为调查对象，对自制医养结合型养老机构老年人服务需求Kano属性问卷进行信效度检验。结果　两轮专家函询的积极系数分别为87.0%和95.0%；专家权威系数分别为0.910和0.927；Kendall W分别为0.309和0.349。经专家函询后确立了包括5个一级条目（生活照料、医疗照护、健康保健、心理社会支持、环境安全）、64个二级条目的医养结合型养老机构老年人服务需求Kano属性问卷。共发放问卷800份，回收有效问卷773份，有效回收率为96.6%。通过Kano模型的5种层次划分，整体服务需求呈现“环境安全>生活照料>医疗照护>心理社会支持>健康保健”的倾向。医养结合型养老机构老年人服务需求Kano属性问卷正向问题的Cronbach's α系数为0.906，生活照料、医疗照护、健康保健、心理社会支持、环境安全Cronbach's α系数依次为0.921、0.901、0.937、0.873、0.902；反向问题的Cronbach's α系数为0.898，各维度Cronbach's α系数依次为0.926、0.881、0.912、0.862、0.894；评价者间一致性水平（IR）为0.859，问卷各条目内容效度指数（I-CVI）为0.833~1.000，全体一致量表内容效度指数（S-CVI/UA）为0.859，平均S-CVI（S-CVI/Ave）为0.977。结论　本研究编制的医养结合型养老机构老年人服务需求Kano属性问卷具有良好的信效度，可以作为机构老年人养老服务需求的评价工具。

关键词: 养老机构, 老年人, 服务需求, 医养结合, 问卷编制, 信度, 效度