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.
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The research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (TC-1403-14049). The statements in this manuscript are solely the authors’ responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Johnson, Maurice C. Jr.; Liu, Helen; Sorra, Joann; Brock, Jane; Gass, Brianna; Li, Jing; Clouser, Jessica Miller; Hirschman, Karen; Carpenter, Deborah; Nguyen, Huong Q.; and Williams, Mark V., "Development and Psychometric Properties of Surveys to Assess Provider Perspectives on the Barriers and Facilitators of Effective Care Transitions" (2021). Center for Health Services Research Faculty Publications. 12.
Additional file 1. Environmental Scan Findings. Surveys and Questionnaires Identified from Project ACHIEVE Provider Survey Environmental Scan. A listing of surveys and questionnaires identified from the Project ACHIEVE environmental scan of provider surveys about the continuity of care and care transitions.
12913_2021_6369_MOESM2_ESM.pdf (808 kB)
Additional file 2. ACHIEVE Provider Survey. ACHIEVE Downstream Provider, Ambulatory Provider, and Hospital Provider Surveys to assess transitional care. A set of surveys to be administered to providers to learn about their work experiences delivering transitional care to patients. Developed by Westat, the Provider Surveys’ goal is to assess the barriers and facilitators in delivering transitional care services and describe the organizational and community contexts in providing transitional care services.
12913_2021_6369_MOESM3_ESM.pdf (512 kB)
Additional file 3. Summary of Responses Table. Summary of Responses Table-Mean, Standard Deviation, Percent Positive, Missing, Does Not Apply/Don’t Know Results. The table includes the mean, standard deviation, percent positive, missing, does not apply/don’t know results of each survey item by provider type.