ABSTRACT
Objective To develop and validate a questionnaire for assessing the synergistic effects of physician col-laboration within a tiered healthcare system,dissect its structural dimensions,and explore the internal logical rela-tionships among these dimensions.Methods Literature review and focus group discussions were employed to clarify the conceptual framework and components of the synergistic effects of physician collaboration in a tiered healthcare system,leading to the development of the questionnaire.Multi-stage sampling was used to survey 1 959 physi-cians.Results The questionnaire for assessing physician collaborative synergy effects consists of four dimensions:col-laborative cognition,collaborative trust,collaborative willingness,and collaborative behavior,comprising 10 items in total.The overall Cronbach's coefficient and the coefficients for four dimensions were all above 0.7.Exploratory factor analysis results extracted four common factors,with a cumulative variance contribution rate of 86.7％.Confirmatory factor analysis revealed that the composite reliability of the four dimensions of the questionnaire was above 0.7,and the average variance extracted was above 0.5.Collaborative cognition influenced collaborative behavior through the chain-mediating roles of collaborative trust and collaborative willingness.Conclusion The developed questionnaire for assessing the synergistic effects of physician collaboration in a tiered healthcare system has good reliability and validity.Its dimensions fit well with the interrelated structure of"knowledge","emotion","intention"and"action",making it a suitable reference tool for evaluating the extent and effectiveness of physician collaboration across different medical institutions within a tiered healthcare system.