Psychometric properties of transitional care instruments and their relationships with health literacy: Brief PREPARED and Care Transitions Measure

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.

Download Full-text

Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions

BMC Health Services Research ◽

10.1186/s12913-021-06766-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joann Sorra ◽

Katarzyna Zebrak ◽

Deborah Carpenter ◽

Theresa Famolaro ◽

John Rauch ◽

...

Keyword(s):

Psychometric Properties ◽

Family Caregiver ◽

Transitional Care ◽

Care Transitions ◽

Internal Consistency Reliability ◽

Patient Survey ◽

Care Patient ◽

Composite Measures ◽

Stay Time

Abstract Background The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. Methods Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. Results The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures—Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) —was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. Conclusions Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.

Download Full-text

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

BMC Health Services Research ◽

10.1186/s12913-021-06369-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maurice C. Johnson ◽

Helen Liu ◽

Joann Sorra ◽

Jane Brock ◽

Brianna Gass ◽

...

Keyword(s):

Patient Care ◽

Psychometric Properties ◽

Transitional Care ◽

Care Transitions ◽

Model Fit ◽

Fit Indices ◽

Pilot Testing ◽

Composite Measures ◽

Effective Care

Abstract Background 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. Methods 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 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). Conclusions 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.

Download Full-text

Involving frail older patients in identifying outcome measures for transitional care—a feasibility study

Research Involvement and Engagement ◽

10.1186/s40900-021-00288-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Troels Kjærskov Hansen ◽

Annesofie Lunde Jensen ◽

Else Marie Damsgaard ◽

Tone Maria Mørck Rubak ◽

Mikkel Erik Juul Jensen ◽

...

Keyword(s):

Health Care ◽

Outcome Measures ◽

Feasibility Study ◽

Thematic Analysis ◽

Older Patients ◽

Public Involvement ◽

Transitional Care ◽

Care Transitions ◽

Level Of Involvement ◽

Relevant Outcome

Abstract Background During care transitions, the older (75+) patient’s agenda can easily be missed. To counteract this, involving patients in shared clinical decision making has proven to be of great value. Likewise, involving patients and other stakeholders as researchers is gaining ground. Patient and public involvement (PPI) in research entails many benefits, for example, by bringing further insight from those with lived experiences of being ill. There are various challenges associated with involving some older patients, for example frailty, cognitive impairment and other chronic illnesses. To the best of our knowledge, there are only a few examples of initiatives involving older patients beyond research participation. The feasibility of involving frail older patients during an ongoing care transition from hospital to primary health care remains unknown. To investigate the feasibility of including older frail patients, their relatives and health care professionals (HCPs) as co-researchers, we established a study with increasingly demanding levels of patient involvement to identify relevant outcome measures for future transitional care research. Methods The study was a pragmatic, qualitative feasibility study. The involved individuals were frail older patients, their relatives and HCPs. Patients and their relatives were interviewed, while the interviewer made reflective notes. A thematic analysis was made. Relatives and HCPs discussed the themes to identify relevant outcome measures and potentially co-create new patient-reported outcome measures (PROMs) for use in future transitional care studies. The feasibility was evaluated according to six involvement steps. The level of involvement was evaluated using the five-levelled Health Canada Public Involvement Continuum (HCPIC). Results In total, eight patients, five relatives and three HCPs were involved in the study. Patients were involved in discussing care transitions (HCPIC level 3), while some relatives were engaged (HCPIC level 4) in forming PROMs. The partnership level of involvement (HCPIC level 5) was not reached. The thematic analysis and the subsequent theme discussion successfully formed PROMs. The key PROMs were related to care, transparency and the relatives’ roles in the transitional care process. Conclusions When applying a pragmatic involvement approach, frail older patients can be successfully involved in identifying relevant transitional care outcome measures; however, involving these patients as fellow researchers seems infeasible. To maintain involvement, supportive relatives are essential. Useful experiences for future research involvement of this vulnerable group were reported, arguing that patient participation has the potential to become inherent in future geriatric research.

Download Full-text

Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?

Innovation in Aging ◽

10.1093/geroni/igaa057.3360 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 914-914

Author(s):

Christine Jones ◽

Jacob Thomas ◽

Marisa Roczen ◽

Kate Ytell ◽

Mark Gritz

Keyword(s):

Health Information ◽

Information Exchange ◽

Transitional Care ◽

Care Transitions ◽

Home Health ◽

Hospital Length Of Stay ◽

Care Hospital ◽

Readmission Rates ◽

Health Agencies ◽

Home Health Agencies

Abstract For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p <0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.

Download Full-text

Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽

10.1161/str.48.suppl_1.tp308 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Janet Prvu Bettger ◽

Sara Jones ◽

Anna Kucharska-Newton ◽

Janet Freburger ◽

Walter Ambrosius ◽

...

Keyword(s):

Transitional Care ◽

Discharge Planning ◽

Care Transitions ◽

Cluster Randomized Trial ◽

Stroke Patients ◽

Care Needs ◽

Post Discharge ◽

Exact Test ◽

Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

Download Full-text

Abstract TP419: Shared Medical Appointments: Supporting Stroke Care Transitions Through Improved Knowledge and Peer Support

Stroke ◽

10.1161/str.47.suppl_1.tp419 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kathleen Burns ◽

Karen S Theodore

Keyword(s):

Risk Factors ◽

Transitional Care ◽

Care Transitions ◽

Individual Risk ◽

Stroke Severity ◽

Stroke Patients ◽

Shared Medical Appointments ◽

Complex Needs ◽

Improved Outcomes ◽

Hospital To Home

Background: Stroke patients have complex needs and are at high risk for complications, making transitional care critical to achieving improved outcomes. Although shared medical appointments (SMAs) are known to improve outcomes for other patient populations, evidence supporting SMA benefit for stroke patient transition from hospital to home is lacking. This study’s purpose was to examine feasibility of participation, patient satisfaction and understanding of key stroke topics following a transitional stroke SMA. Methods: Inclusion criteria for this study included: age 18 years or older, hospitalized for stroke/TIA, and planned discharge to home. Individuals with deficits impairing group participation were excluded. Eligible patients were educated on and invited to attend a SMA occurring 1-2weeks after hospital discharge. The SMA included a private exam and interactive group session to address key stroke topics: 1) medication compliance 2) individual risk factors, 3) secondary prevention, 4) signs of stroke and 5) actions for signs of stroke. Following the SMA, participants completed a two-part survey seeking a) a yes/no response to assess increased understanding of stroke topics, and b) level of agreement on satisfaction with the SMA format. Responses were analyzed using descriptive statistics. Results: While 15 patients agreed to participate prior to discharge, only eight attended the SMA. Attendees were primarily male (75%) with an ischemic stroke diagnosis (63%). The majority who did not attend were female (71%) and without family present during in-hospital education and invitation (86%). Age, stroke severity and stroke risk factors for both groups were otherwise similar. All participants reported an increased understanding of all stroke topics and 95% were satisfied with the SMA. Conclusion: Findings support use of SMAs for stroke patients transitioning from hospital to home. Reinforcing key stroke topics in a peer supported environment may increase understanding and compliance, leading to improved outcomes. Additional research is warranted to explore barriers to SMA participation.

Download Full-text

Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine

BMJ Open ◽

10.1136/bmjopen-2019-034943 ◽

2020 ◽

Vol 10 (6) ◽

pp. e034943

Author(s):

Mohammed B A Sarhan ◽

Harry S Shannon ◽

Rika Fujiya ◽

Masamine Jimba ◽

Rita Giacaman

Keyword(s):

Health Literacy ◽

Psychometric Properties ◽

Arabic Language ◽

Arab Countries ◽

Assessment Scale ◽

Functional Health ◽

Functional Health Literacy ◽

Literacy Assessment ◽

Cronbach’S Alpha ◽

Cronbach's Alpha

ObjectivesHealth literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties.DesignWe conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews.Setting and participantsWe conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017.MethodsWe translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach’s alpha, MacDonald’s omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale’s average inter-item correlation.ResultsEFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach’s alpha, MacDonald’s omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59.ConclusionHAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

Download Full-text

Short Assessment of Health Literacy for Portuguese-speaking Adults

Revista de Saúde Pública ◽

10.1590/s0034-89102012005000047 ◽

2012 ◽

Vol 46 (4) ◽

pp. 702-711 ◽

Cited By ~ 48

Author(s):

Daniel Apolinario ◽

Rafaela de Castro Oliveira Pereira Braga ◽

Regina Miksian Magaldi ◽

Alexandre Leopold Busse ◽

Flavia Campora ◽

...

Keyword(s):

Older Adults ◽

Health Literacy ◽

Construct Validity ◽

Psychometric Properties ◽

Assessment Tool ◽

Characteristic Curve ◽

Intraclass Correlation ◽

Validity And Reliability ◽

Convenience Sample ◽

Inadequate Health Literacy

OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.

Download Full-text

EMERGING MODELS OF CARE: THE IMPACT OF PHARMACIST-LED MEDICATION MANAGEMENT IN A TRANSITIONAL CARE PROGRAM

Innovation in Aging ◽

10.1093/geroni/igz038.2602 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S708-S708

Author(s):

Ebony Andrews ◽

Travonia Brown-Hughes ◽

Ronald Lyon ◽

Shanea D Parker ◽

Brad Lazernick

Keyword(s):

Transitional Care ◽

Medication Management ◽

Hospital Readmissions ◽

Care Transitions ◽

Patient Activation ◽

Care Program ◽

Transition Process ◽

Models Of Care ◽

Care Transition ◽

The Impact

Abstract Transitional care programs have emerged as successful models of care in which to reduce cost and improve health outcomes. However, few transitional care models have directly incorporated the expertise of the pharmacist as an integral member of the care coordination team. Therein lies an inherent limitation of many community-based transitional care programs, the underutilization of pharmacist during all stages of the care transition process. In 2013, the Hampton Roads Care Transitions Project (HRCTP), a partnership between Senior Services of Southeastern Virginia Area Agency on Aging in Norfolk, VA and Hampton University School of Pharmacy, was established. The goal of the HRCTP is to provide medication management services to reduce preventable hospital readmissions for adults 60 years of age and older with targeted diagnoses. Pharmacists work in collaboration with social workers who act as HRCTP care transition coaches. Between May 2017- October 2018, 678 patients were enrolled in the HRCTP. The hospital readmission rate among patients with targeted diagnoses was reduced by 55.3% with an absolute percentage point reduction of 9.9% and estimated savings amount per avoided readmission of $14,400. Patients who participated in the HRCTP showed a 14% increase in the Patient Activation Assessment indicating an improvement in self-managing efficacy. 93% of patients/caregivers indicated they felt more confident in their ability to manage their health, and 91% expressed satisfaction with the program. The program has proven effective in assisting seniors to remain in their home, reducing hospitalizations, promoting health, increasing patient satisfaction, and reducing healthcare cost.

Download Full-text