Joseph Lallu, Deshmukh Rahul, Murugesan Malathi, Nair Neesha Ajit, Antony Ebinesh, Ramasubramani Premkumar, Karuppusami Reka, Ravindran Pratheesh
Quality Manager and Associate General Superintendent, Christian Medical College Vellore, Vellore, Tamilnadu, India.
Medical Director and HOD Anaesthesiology, Medcare Orthopaedics and Spine Hospital, Dubai, Dubai, UAE.
BMJ Open Qual. 2025 Aug 7;14(3):e003345. doi: 10.1136/bmjoq-2025-003345.
Patient-reported experience measures (PREMs) offer unique insights into patient perceptions of care. However, their implementation at the micro level with regards to patient safety remains limited. This study aimed to repurpose PREMs to co-produce validated, context-specific PREMs tools aimed at improving patient safety.
A prospective mixed method approach was used to design PREMs-based tools. This multiphase study was conducted from September 2023 to April 2024. In phase 1, a core group identified 17 key processes to devise the PREMs tools. In phase 2, focus group discussions were conducted by the multidisciplinary principal teams to finalise the standard operating procedures for each key process and prepare the respective PREMs questionnaires. Patient safety was the primary construct. Relevant stakeholders, including patients, participated in the face and content validation of each PREMs tool during phase 3. Content Validity Index (CVI) was calculated using three indices, namely, item level CVI (I-CVI), scale-level CVI (S-CVI) and content validity ratio (CVR). The reliability of the questionnaires was checked using Kuder-Richardson Formula 20 (KR-20) values with pilot tests on patients.
17 checklist format PREMs tools were developed. The I-CVI values for all the items in the questionnaires ranged from 0.73 to 1.00 and the CVR values ranged from 0.46 to 1.00. The S-CVI/AVG ranged from 0.89 to 1.00. These indicated strong content validity for all items and questionnaires. The reliability analysis for the 17 studies, based on the KR-20 values, ranged from 0.4324 to 0.9455. Except for 'fall prevention', all tools showed good internal consistency.
We offer a battery of patient safety oriented PREMs tools. Co-production of PREMs tools across an extensive range of patient care processes offers significant potential in patient safety implementation in addition to patient engagement.
患者报告体验测量（PREMs）能为患者对医疗护理的看法提供独特见解。然而，其在微观层面针对患者安全的实施仍然有限。本研究旨在重新利用PREMs共同制作经过验证的、针对特定情境的PREMs工具，以提高患者安全。
采用前瞻性混合方法设计基于PREMs的工具。这项多阶段研究于2023年9月至2024年4月进行。在第一阶段，一个核心小组确定了17个关键流程，以设计PREMs工具。在第二阶段，多学科主要团队进行焦点小组讨论，以确定每个关键流程的标准操作程序，并准备各自的PREMs问卷。患者安全是主要构建内容。包括患者在内的相关利益相关者在第三阶段参与了每个PREMs工具的表面效度和内容效度验证。使用项目水平内容效度指数（I-CVI）、量表水平内容效度指数（S-CVI）和内容效度比率（CVR）这三个指数计算内容效度指数（CVI）。通过对患者进行预测试，使用库德-理查森公式20（KR-20）值检查问卷的信度。
开发了17种清单格式的PREMs工具。问卷中所有项目的I-CVI值范围为0.73至1.00，CVR值范围为0.46至1.00。S-CVI/AVG范围为0.89至1.00。这些表明所有项目和问卷都具有很强的内容效度。基于KR-20值对17项研究进行的信度分析范围为0.4324至0.9455。除了“预防跌倒”外，所有工具都显示出良好的内部一致性。
我们提供了一系列以患者安全为导向的PREMs工具。在广泛的患者护理流程中共同制作PREMs工具，除了能促进患者参与外，并在患者安全实施方面具有巨大潜力。
