Assessing the Quality of Preparation for Posthospital Care from the Patient's Perspective: The Care Transitions Measure

Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado 80011, USA.
Medical Care (Impact Factor: 3.23). 04/2005; 43(3):246-55.
Source: PubMed


Evidence that both quality and patient safety are jeopardized for patients undergoing transitions across care settings continues to expand. Performance measurement is one potential strategy towards improving the quality of transitional care. A valid and reliable self-report measure of the quality of care transitions is needed that is both consistent with the concept of patient-centeredness and useful for the purpose of performance measurement and quality improvement.
We sought to develop and test a self-report measure of the quality of care transitions that captures the patient's perspective and has demonstrated utility for quality improvement.
Patients aged 18 years and older discharged from one of the 3 hospitals of a vertically integrated health system were included.
Cross-sectional assessment of factor structure, dimensionality, and construct validity.
The Care Transitions Measure (CTM), a 15-item uni-dimensional measure of the quality of preparation for care transitions, was found to have high internal consistency, reliability, and reflect 4 focus group-derived content domains. The measure was shown to discriminate between patients discharged from the hospital who did and did not have a subsequent emergency department visit or rehospitalization for their index condition. CTM scores were significantly different between health care facilities known to vary in level of system integration.
The CTM not only provides meaningful, patient-centered insight into the quality of care transitions, but because of the association between CTM scores and undesirable utilization outcomes, it also provides information that may be useful to clinicians, hospital administrators, quality improvement entities, and third party payers.

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    • "Answers are rated on a 4-point scale from “strongly disagree” to “strongly agree”. The CTM scale score (0 to 100) has evinced high internal consistency and reliability (Cronbach’s alpha 0.93) [37]. The CTM had previously been translated into Hebrew, Arabic and Russian. "
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    ABSTRACT: Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care. Methods This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit. Results Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01). Conclusion Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.
    Israel Journal of Health Policy Research 07/2014; 3(1):24. DOI:10.1186/2045-4015-3-24
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    • "In turn, this leads to particular problems at the transition points between care sectors. Patients report problems with respect to coordination and cooperation between healthcare providers, with the consequence that problems in patient safety and quality of care arise [4, 5]. The current challenge posed is to expand quality assurance to include a cross-sectoral focus [3]. "
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    ABSTRACT: /st>The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors. /st>Mixed-methods design including focus groups, pretests and field test. /st>The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors. /st>For the field test, 589 questionnaires were distributed to patients via 47 general practices. entsDescriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care. /st>The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics 'Indication', including shared-decision-making (6 items, 24.5-62.9%) and 'Discharge and Transition' (10 items; 20.7-48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8-9.3%) confirmed a high acceptance by patients. /st>The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.
    International Journal for Quality in Health Care 04/2014; 26(3). DOI:10.1093/intqhc/mzu044 · 1.76 Impact Factor
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    • "When older adults with complex medical issues experience a care transition, multiple health professionals from different disciplines are involved across various settings, expanding the patient’s circle of care [6]. It is during these types of complex transitions, where quality of care and patient safety have been found to be at greatest risk [7–13]. Outcomes of poor transitional care include medication errors [14], increased use of hospital, ambulatory, and emergency services [15, 16] as well as poor client satisfaction [17]. "
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    ABSTRACT: Miscommunication and lack of coordination can compromise care quality and patient safety during transitions in care, especially for medically complex older adults. Little research has been done to investigate care transitions from the perspective of those receiving and providing care. This study explored multiple care transitions for an elderly hip fracture patient, post-surgery. Interviews and observations were conducted with the patient, their family caregivers, and health care providers, at each point of transition between four different care settings. FOUR KEY THEMES WERE IDENTIFIED OVER THE PATIENTS CARE TRAJECTORY: 'Missing Crucial Coversations'-Patient and family caregivers did not feel involved or informed about decisions in care; 'Who's Who'-Confusion about the role of health care providers; 'Ready or Not'-Not knowing what to expect or what is expected; and, 'Playing by the Rules'-Health system policies and procedures hinder individualized care. Study findings point to the need for the health care system to engage patients and family caregivers more fully and consistently in the process of care transitions as well as the importance of understanding these processes from multiple perspectives. Recommendations for system integration are proposed with a focus on transitional care.
    International journal of integrated care 04/2013; 13:e023. · 1.50 Impact Factor
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