Westat, 1600 Research Boulevard, Rockville, MD, USA.
Telligen Quality Improvement Organization, Denver, CO, USA.
BMC Health Serv Res. 2021 May 20;21(1):478. doi: 10.1186/s12913-021-06369-5.
The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers' perspectives on current practices in delivering transitional care services.
We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites' psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items.
Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71).
We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.
出院流程的质量和医疗保健服务之间的有效交接对于尽量减少患者护理中的差距和降低医院再入院率至关重要。很少有研究探讨哪些交接环节和策略对患者和提供者最有价值。本研究描述了开发、试点测试和心理测量分析调查问卷的过程，旨在了解提供者对提供过渡性护理服务的当前实践的看法。
我们经历了一个全面的过程，从三种类型的提供者（下游、门诊和医院提供者）的角度开发了用于衡量交接环节的独特方面的项目。这个过程包括 1）环境扫描，2）提供者访谈，3）调查认知测试，4）试点测试，5）利益相关者咨询小组，6）科学咨询委员会，7）一个名为 ACHIEVE（通过评估证据价值来实现以患者为中心的护理和优化医疗保健交接）的合作研究团队。我们开发并向参与 ACHIEVE 项目的 43 家医院的提供者发放了三份调查问卷。通过网络调查管理，共获得了 948 名提供者的回复。我们评估了回复的可变性和缺失情况。为了评估综合指标的心理测量学特性，我们考察了调查项目之间的相关性、项目因子负荷、模型拟合指数、内部一致性可靠性以及综合指标与总体评分项目之间的相关性。
对三份调查问卷的心理测量学分析结果支持了五个综合指标的有效性：1）协调患者护理的努力，2）收到的患者信息质量，3）过渡性护理的组织支持，4）获得社区资源的途径，5）社区提供者之间的关系强度。所有因子负荷和可靠性估计都可以接受（负荷≥0.40，α≥0.70），且拟合指数显示出良好的模型拟合度。所有综合指标与总体评分呈正相关（0.13≤r≤0.71）。
我们确定，该调查中评估交接环节障碍和促进因素的项目和综合指标具有可靠性，且表现出令人满意的心理测量学特性。这些工具可能对医疗保健组织和研究人员有用，可用于评估不同提供者环境中的交接质量，并确定需要改进的领域。
