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.
Combining paid work and family care for a patient at the end of life at home: insights from a qualitative study among caregivers in the Netherlands
