Development and Psychometric Properties of Surveys to Assess Patient and Family Caregiver Experience With Care Transitions

Abstract

Background The purpose of this study was to develop and administer surveys that assess patient and caregiver experience with care transitions and examine the psychometric properties of the surveys. The surveys were designed to include the transitional care services or components of care, provided in the hospital and at home, that matter most to patients and their family caregivers, as well as their assessments of the overall quality of the transitional care they received. Methods Patients were recruited prior to discharge from 43 U.S. hospitals. The analysis dataset included responses from 9,282 patients, 1,245 Time 1 caregivers (who helped the patient in the hospital), and 1,749 Time 2 caregivers (who helped the patient at home). The psychometric properties of the survey items and composite measures were examined for each of the three surveys, including (1) item response variability and missing data, (2) exploratory factor analysis, (3) internal consistency and site-level reliability, and (4) correlations among the outcome composite measures and with other survey items. Items that performed poorly across multiple analyses were dropped from the final instruments. Results Overall, the final patient and caregiver surveys had acceptable psychometric properties, with a few exceptions. Exploratory factor analyses supported the composite measures, which had acceptable internal consistency reliability—Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys). All surveys had acceptable site-level reliability except when the sample sizes needed to achieve 0.70 site-level reliability were higher than the actual sample sizes in the dataset. In all surveys, the Overall Quality of Transitional Care composite measure was significantly correlated with other composite measures and most of the survey items. Conclusions The final patient, T1 caregiver, and T2 caregiver surveys are psychometrically sounds and can be used by health systems, hospitals, and researchers to assess patient and caregiver experience with care transitions. Results from these surveys can be used as the basis for making improvements to transitional care delivery that are centered on what matters most to patients and their family caregivers.

Development and psychometric properties of surveys to assess provider perspectives on the barriers and facilitators of effective care transitions

“…Future studies could recruit providers who are representative of the staff positions within organizations and levels of engagement with integrated transitional care programs to address this limitation. It would also be beneficial to investigate how the Provider Survey's composite measures relate to patient outcomes, including those in the Project ACHIEVE patient and caregiver surveys [42], and whether topperforming hospitals in these measures would affect readmission rates or patient satisfaction with care. Finally, while we determined the instruments to be psychometrically sound, additional analyses could help compare the relative strength of the relationship between the proposed measures across care settings.…”

Caregiver Inclusion in IDEAL Discharge Teaching

“…Large-scale care transition studies have begun identifying a host of organizational factors impacting quality and outcomes of care transitions, including implementation of strategies for clear communication and fostering trust with both patients and caregivers (Naylor et al, 2017; Sorra et al, 2021). In concert with these efforts, the Agency for Healthcare Research and Quality (AHRQ) has directly addressed the role of caregivers and offers a structured discharge planning process intended to improve discharge planning and reduce adverse events postdischarge (Agency for Healthcare Research and Quality, 2013).…”