Anatchkova Milena D, Barysauskas Constance M, Kinney Rebecca L, Kiefe Catarina I, Ash Arlene S, Lombardini Lisa, Allison Jeroan J
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.).
Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA (C.M.B.).
J Am Heart Assoc. 2014 Jun 4;3(3):e001053. doi: 10.1161/JAHA.114.001053.
The quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM-15) was developed with a classic test theory approach; its short version (CTM-3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure.
As part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form-36), CTM-15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM-15-, CTM-3-, and CTM-IRT-based score using relative validity. Participants were 79% non-Hispanic white and 67% male, with an average age of 62 years. The CTM-15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded "Strongly agree" and 19% responded "Agree" to all items) and limited score variability. These problems were more pronounced for the CTM-3. The CTM-15 differentiated between patient groups defined by self-reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM-3 was not significantly lower for patients reporting rehospitalization or emergency department visits.
We identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.
过渡性护理质量与再住院和费用等重要健康结局相关。广泛使用的护理过渡性测量指标（CTM - 15）是采用经典测试理论方法开发的；其简短版本（CTM - 3）被纳入了医疗保健消费者评估医院调查（CAHPS）。我们对这两个指标进行了心理测量学评估，并探讨了项目反应理论（IRT）是否能产生更精确的测量指标。
作为冠心病事件结局研究与教育中心的过渡、风险与行动研究的一部分，在急性冠状动脉综合征住院期间对1545名参与者进行了访谈，收集了其出院后1个月时的一般健康状况（简短健康调查问卷 - 36）、CTM - 15、医疗利用情况以及护理过程问题等信息。我们采用经典分析和IRT分析，并使用相对效度比较基于CTM - 15、CTM - 3和CTM - IRT评分的测量精度。参与者中79%为非西班牙裔白人，67%为男性，平均年龄62岁。CTM - 15具有良好的内部一致性（Cronbach's α = 0.95），但存在默许偏差（8.7%的参与者对所有项目回答“强烈同意”，19%回答“同意”）且评分变异性有限。这些问题在CTM - 3中更为明显。CTM - 15能够区分由自我报告的健康状况、医疗保健利用情况和护理过渡过程指标所定义的患者组。组间差异较小（2至3分）。IRT评分在测量精度上没有提高。报告再住院或急诊就诊的患者的CTM - 3得分没有显著更低。
我们确定了CTM在心理测量学方面的挑战，这可能会限制其在研究和实践中的价值。这些结果与该测量指标效度存在差距的新证据一致。
