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Care Transitions Measure

Instrument Author:

Coleman, E. A., Mahoney, E., & Parry, C.

Source title:

 
Assessing the Quality of Preparation for Post-hospital Care from the Patient’s Perspective
 

Source:

 
Coleman, E. A., Mahoney, E., & Parry, C. (2005). Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure. [Comparative Study Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.]. Medical Care, 43(3), 246-255.
 

Source Author:

Coleman, E. A., Mahoney, E., & Parry, C.

Journal Name:

 
Medical Care

Volume:

 
43

Issue/Part:

 
3

Year:

 
2005

Pagination:

 
246-55
 

Abstract:

 
BACKGROUND: 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. OBJECTIVE: 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. SUBJECTS: Patients aged 18 years and older discharged from one of the 3 hospitals of a vertically integrated health system were included. RESEARCH DESIGN: Cross-sectional assessment of factor structure, dimensionality, and construct validity. RESULTS: 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. CONCLUSIONS: 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.
 

Descriptors:

 
Care transition
Coordinated care
Patient-centered care
Quality measurement
Quality of care
 

Number of questions:

 
15
 

Response Options:

 
4 point response scale (strongly agree; agree; disagree; strongly disagree)
 

Validity:

 
Article describes Construct Validity in detail. Researcher should review article for full details of these psychometric properties estimates.
 

Reliability:

 
This measure has high internal consistency and reliability with Crohnbach’s alpha for the 15-item measure of .93. This measure has been administered between 14-28 days post transition.
 

Subscale/Factors:

 
4 domains: Critical Understanding, Preferences Important, Management Preparation, Care Plan
 

Sample Descriptors:

 
Adult
Discharged patient
United States
 

Sample Items:

 
“When I left the hospital, I clearly understood how to manage my health.”
 

Measure Descriptors:

 
Quality of care transitions

References:

  1. Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51:556 –557.
  2. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51:549 –555.
  3. Naylor M, Bowles K, Brooten D. Patient problems and advanced practice nurse interventions during transitional care. Public Health Nurs. 2000;17:94 –102.
  4. Kiely DK, Bergmann MA, Murphy KM, et al. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol Ser A. 2003;58:M441–M445.
  5. Levine C. Rough Crossings: Family Caregivers Odysseys Through the Health Care System. New York, NY: United Hospital Fund of New York; 1998.
  6. Coleman EA, Eilertsen T, Smith J, et al. Development and testing of a measure designed to assess the quality of care transitions. Int J Integrated Care. 1 June 2002; Available from: http://www.ijic.org. Accessed December 16, 2004.
  7. Vom Eigen K, Walker J, Edgman-Levitan S, et al. Carepartner experiences with hospital care. Med Care. 1999;37:33–38.
  8. Ellers B, Walker J. Facilitating the transition out of the hospital. In: Gerteis M, Edgman-Levitan S, Daley J, et al, editors. Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco: Jossey-Bass; 1993:204 –223.
  9. Wachter R, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287:487– 494.
  10. Katz T, Walke L, Jacobs L. A geriatric hospitalist program for nursing home residents. Ann Long Term Care. 2000;8:51–56.
  11. Joint Commission on Accreditation of Healthcare Organizations. Health Centers’ Most Challenging Standards. April 2003. Accessed December 16, 2004.
  12. Centers for Medicare and Medicaid Services. Conditions of participation:discharge planning. Fed Regis. 2001;Section 482. 43(42(3)):503–504.
  13. Halm E, Magaziner J, Hannan E, et al. Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med. 2003;163:107–112.
  14. Forster A, Murff H, Peterson J, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–167.
  15. Boockvar K, Halm E, Litke A, et al. Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc. 2003;51:399–403.
  16. Moore C, Wisnevesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–651.
  17. Beers M, Sliwkowski J, Brooks J. Compliance with medication orders among the elderly after hospital discharge. Hosp Formul. 1992;27:720–724.
  18. Bull M. Patients’ and professionals’ perceptions of quality in discharge planning. J Nurs Care Qual. 1994;8:47– 61.
  19. Institute of Medicine. Crossing the Quality Chasm: A New Health System of the 21st Century. Committee on Quality of Health Care in America, editor. Washington, DC: National Academy Press; 2001.
  20. Agency for Healthcare Research and Quality RM. Measuring patient’s hospital care experiences: development of a national standard. June 2002. Available from: http://www.ahrq.gov/qual/hspcahps.htm. Accessed December 16, 2004.
  21. Agency for Healthcare Research and Quality RM. Update on hospital CAHPS (HCAHPS). February 2003. Available from: http://www.ahrq.gov/qual/cahps/hcahpsupdate.htm. Accessed December 16, 2004.
  22. Wenger NS, Young R. Quality Indicators for Continuity and Coordination of Care in Vulnerable Elders. 2003. Accessed December 16, 2004.
  23. Bonomi A, Wagner E, Glasgow R, et al. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2003;37:791– 820.
  24. National Chronic Care Consortium. Self-assessment for system integration tool. SASI 1998. Available from: http://www.nccconline.org/SASI/SASI_Objectives.pdf. Accessed December 16, 2004.
  25. Hendriks A, Vrielink M, Smets E, et al. Improving the assessment of (In)patients’ satisfaction with hospital care. Med Care. 2001;39:270–283.
  26. Coleman EA, Eilertsen T, Smith JD, et al. Developing and testing of a measure designed to assess the quality of care transitions (abstract). J Am Geriatr Soc. 2002;50(4 suppl):S7.
  27. Muthen LMB. Mplus Statistical Analysis with Latent Variables. Version 2. Los Angeles: Muthen and Muthen; 2001.
  28. MacCallum R. Specification searches in covariance structure modeling. Psychol Bull. 1986;100:107–120.
  29. Joreskog K. Testing structural equation models. In: Bollen KA, Long JS, editors. Testing Structural Equation Models. Thousand Oaks, CA: SAGE Publications; 1993.
  30. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107:238 –246.
  31. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equation Model. 2001;6:1–55.
  32. Yu C-Y, Muthen B. Evaluation of model fit indices for latent variable models with categorical and continuous outcomes. In: Muthen B, Muthen L, eds. Technical Report. Los Angeles, CA: Mplus; 2001:362
  33. Grimmer K, Moss J. The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective. Int J Qual Health Care. 2001;13:109 –116.
  34. Hedges G, Grimmer K, Moss J, et al. Performance indicators for discharge planning: a focused review of the literature. Aus J Adv Nursing. 1999;16:20 –28.
  35. Parkes J, Shepperd S. Discharge planning from hospital to home (Cochrane Review). The Cochrane Library 3. 2003.
  36. The Leapfrog Group. Purchasing Principles. 2003. Available from: http://www.leapfroggroup.org/about_us/leapfrog-factsheet. Accessed December 16, 2004.
  37. California Health Care Foundation. Results from the Patients’ Evaluation of Performance (PEP-C) Survey. 2003. Available from: http:// www.chcf.org/documents/consumer/quality/PEPCTechReport.pdf. Accessed December 16, 2004.
  38. Anonymous. History of IHA’s Pay for Performance Initiative. 2003. Available from: http://www.iha.org/payfprfd.htm. Accessed December 16, 2004.

Readability Index:

 n/a

Availability:

 Contact author: Eric.Coleman@uchsc.edu

Acronym:

 
CTM

DOI:

 
n/a

ISBN:

 
n/a

ISSN:

 
0025-7079
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