Health Promotion Board, Singapore, Singapore.
BMC Health Serv Res. 2012 Aug 16;12:256. doi: 10.1186/1472-6963-12-256.
The 15-item Care Transition Measure (CTM-15) is a measure for assessing the quality of care during transition from the patients' perspective. The purpose of this study was to test the psychometric properties of the CTM-15 and CTM-3 (a 3-item version of the CTM-15) in Singapore, a multi-ethnic urban state in South-east Asia.
A consecutive sample of patients was recruited from two tertiary hospitals. The subjects or their proxies were interviewed 3 weeks after discharge from hospital to home in English or Chinese using the CTM-15 questionnaire. Information about patients' visit to emergency department (ED), non-elective rehospitalisation for the condition of index hospitalisation, and care experience after discharge was also collected from respondents. Psychometric properties of CTM-15 and CTM-3 based on the five-point response scale (i.e. strongly disagree, disagree, neutral, agree, and strongly agree) and the three-point response scale (i.e. [strongly] agree, neutral, and [strongly] disagree) were tested for English and Chinese versions separately. Internal consistency reliability was assessed using Cronbach's alpha and construct validity was tested with T-test or Pearson's correlation by examining hypothesised association of CTM scores with ED visit, rehospitalisation, and experience with care after discharge. Exploratory factor analysis was performed to examine latent dimensions of CTM-15.
A total of 414 (proxy: 96.1%) and 165 (proxy: 84.8%) subjects completed the interviews in English and Chinese, respectively. Cronbach's alpha values of the different CTM-15 versions ranged from 0.81 to 0.87. In contrast, Cronbach's alpha values of the CTM-3 ranged from 0.42 to 0.63. Both CTM-15 and CTM-3 were correlated with care experience after discharge regardless of survey language or response scale (Pearson's correlation coefficient: 0.36 to 0.46). Among the English-speaking respondents, the CTM-15 and CTM-3 scores based on both the three- and five-point response scales discriminated well between patients with and without ED visits or rehospitalisation for their index condition. Among Chinese-speaking respondents, no difference in CTM scores was observed between patients with and without ED visits or patients with and without rehospitalisation. The English and Chinese versions of the CTM-15 items demonstrated a similar 4-factor structure representing general care plan, medication, agreement on care plan, and specific care instructions.
The care transition measure is a valid and reliable measure for quality of care transition in Singapore. Moreover, the care transition measure can be administered to proxies using a simpler response scale. The discriminatory power of the Chinese version of this instrument needs to be further tested in future studies.
15 项护理过渡措施（CTM-15）是一种从患者角度评估过渡期间护理质量的措施。本研究的目的是在新加坡（东南亚的一个多民族城市国家）测试 CTM-15 和 CTM-3（CTM-15 的 3 项版本）的心理测量特性。
连续招募了两家三级医院的患者。在出院后 3 周内，使用 CTM-15 问卷通过英语或中文对患者或其代理人进行访谈。还从受访者那里收集了有关患者就诊急诊部（ED）、因索引住院的病情非选择性再次住院以及出院后护理体验的信息。分别基于五分制（即非常不同意、不同意、中立、同意和非常同意）和三分制（即[强烈]同意、中立和[强烈]不同意）对 CTM-15 和 CTM-3 的心理测量特性进行了测试。使用 Cronbach's alpha 评估内部一致性可靠性，通过检验 CTM 分数与 ED 就诊、再住院和出院后护理体验之间假设的关联来检验结构有效性。进行探索性因素分析以检查 CTM-15 的潜在维度。
共有 414 名（代理人：96.1%）和 165 名（代理人：84.8%）患者分别用英语和中文完成了访谈。不同 CTM-15 版本的 Cronbach's alpha 值范围为 0.81 至 0.87。相比之下，CTM-3 的 Cronbach's alpha 值范围为 0.42 至 0.63。无论调查语言或响应量表如何（皮尔逊相关系数：0.36 至 0.46），CTM-15 和 CTM-3 均与出院后的护理体验相关。在讲英语的受访者中，基于三分制和五分制的 CTM-15 和 CTM-3 评分可以很好地区分是否有 ED 就诊或因索引疾病再次住院。在讲中文的受访者中，ED 就诊和再次住院的患者之间的 CTM 评分没有差异。CTM-15 各项的英文和中文版本表现出相似的 4 因素结构，代表一般护理计划、药物、护理计划的一致性和具体护理说明。
护理过渡措施是新加坡评估护理过渡质量的有效且可靠的措施。此外，可以使用更简单的响应量表向代理人管理护理过渡措施。该工具的中文版本的区分能力需要在未来的研究中进一步测试。
