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Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Nyköping Hospital, Sörmland County Council, Nyköping; Center for Clinical Research Sörmland, Uppsala University, Eskilstuna.
Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar; Department of Research, Region Kalmar County, Kalmar.
Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Center for Clinical Research Sörmland, Uppsala University, Eskilstuna.ORCID iD: 0000-0002-7957-8600
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2023 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 26, no 3, p. 1137-1148Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ.

METHODS: This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ.

RESULTS: A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated.

CONCLUSION: The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization.

PATIENT OR PUBLIC CONTRIBUTION: Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.

Place, publisher, year, edition, pages
WILEY , 2023. Vol. 26, no 3, p. 1137-1148
Keywords [en]
Continuity of care, Patient discharge, Psychometrics, Quality of care, Reproducibility of results, Surveys and questionnaires, Validation studies
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-192084DOI: 10.1111/hex.13728ISI: 000939223500001PubMedID: 36797976OAI: oai:DiVA.org:liu-192084DiVA, id: diva2:1740385
Note

Funding agencies: The Center for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden: DLL-939621. DLL-930272, DLL-859581, DLL-742221, DLL-642411, and the Medical Research Council of Southeast Sweden: FORSS-607341, FORSS-749931, FORSS-846301

Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2024-02-02Bibliographically approved
In thesis
1. Continuity of care after hospitalization due to cardiac conditions: Patients' perceptions, validity and reliability of a measure, and associations with outcomes
Open this publication in new window or tab >>Continuity of care after hospitalization due to cardiac conditions: Patients' perceptions, validity and reliability of a measure, and associations with outcomes
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cardiac conditions are a common cause of hospitalization worldwide. The need for healthcare continues after hospital discharge and most commonly includes follow-up within primary healthcare centers or specialized outpatient cardiology clinics. This transition from the hospital to outpatient or primary-care settings jeopardizes the continuity of care. Continuity of care refers to the coordination of healthcare between different healthcare personnel and settings over time. There are three types of continuity of care: informational, relational, and management continuity. Continuity of care is essential after hospitalization due to cardiac conditions, and is associated with several positive clinical outcomes; however, available patient-reported measures of continuity of care during the posthospital period needs further validation. Accurate measurements would improve our ability to evaluate implementations designed to enhance continuity of care. Moreover, there is a lack of knowledge about whether the associations between continuity of care, perceived control, and self-care could explain variations in health-related quality of life and hospital readmissions in patients with cardiac conditions.

Aim: The overall aim of this thesis was to contribute to improving care after hospitalization for patients with cardiac conditions by describing continuity of care from the patient’s perspective and increasing the understanding of how continuity of care can be measured and how it can influence patient outcomes.

Method: All four studies had a cross-sectional design using a consecutive sampling procedure (I–IV). Study I was a single-center study and studies II–IV were multicenter studies. Data was collected using structured telephone interviews (I), questionnaires (II–IV), and review of medical charts (I–IV). The timescale for data collection ranged from one week (I) to six weeks after discharge (II–IV). The Patient Continuity of Care Questionnaire (PCCQ), a 27-item questionnaire to measure patients’ perceptions of continuity of care, was translated and culturally adapted to Swedish. The factor structure was reviewed (II), and a short version including 12 of the items was evaluated (III). A conceptual model was constructed to examine the associations between continuity of care, perceived control, self-care, health-related quality of life, and hospital readmissions (IV). The data was analyzed using descriptive and non-parametric statistics (I), confirmatory factor analysis, test-retest estimation (II), the Rasch measurement model (III), and structural equation modeling (SEM) (IV).

Results: Patients in study I were hospitalized due to heart failure, and in study II–IV, patients hospitalized due to angina pectoris, atrial fibrillation, heart failure and myocardial infarction were included. Most patients received a written discharge summary. Despite this, many patients lacked knowledge about whom to contact regarding deterioration or questions after discharge. The patients described feeling unsafe and experienced a lack of clarity about their primary healthcare contact (I). The confirmatory factor analysis of the Swedish version of the PCCQ overall confirmed the sixfactor structure, but minor revisions were made to achieve a satisfactory model fit. The ordinal alpha for the subscales was satisfactory and ranged between 0.82 and 0.95 (II). In the 12-item short version (PCCQ-12) (III), two pairs of items showed signs of response dependence and the first two response options were disordered in all items. Apart from this, the PCCQ-12 was found to be a unidimensional questionnaire with sound psychometric properties and the ordinal alpha was 0.94. Patients most commonly reported lower levels of continuity of care on matters relating to management continuity after discharge. In particular, women, older patients, and those hospitalized due to angina pectoris reported lower levels of continuity. In study IV, the conceptual model suggested that patients who perceive higher levels of continuity of care also experience higher levels of perceived control and perform self-care to a greater extent, significantly improving their health-related quality of life and reducing the risk of hospital readmission. The association between continuity of care and self-care was mediated by perceived control.

Conclusion: Patients’ perceptions of continuity of care after hospitalization due to cardiac conditions can be measured using the PCCQ. The longer, revised PCCQ can be used to evaluate the three types of continuity individually, and the PCCQ-12 can be used in a time-restricted setting or to reduce respondents’ burden. Even though most patients received a written discharge summary, this was not enough for them to perceive continuity of care after hospitalization. An area of concern is management continuity and elderly patients, women, and those hospitalized due to angina pectoris. Finally, according to the conceptual model, interventions aiming to improve health-related quality of life or reduce readmission should include actions to facilitate continuity of care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 97
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1840
Keywords
Cardiac disease, Conceptual models of nursing, Continuity of care, Discharge planning, Perceived control, Psychometrics, Quality of care, Quality of life, Self-care, Validation studies
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-192088 (URN)10.3384/9789180750486 (DOI)9789180750479 (ISBN)9789180750486 (ISBN)
Public defence
2023-03-31, Hasselquistsalen, Building 511, Campus US, Linköping, 09:00 (Swedish)
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Supervisors
Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2023-03-14Bibliographically approved

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Säfström, EmmaLiljeroos, MariaJaarsma, TinyStrömberg, Anna

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