Development of an instrument for the measurement of patients’ perception of care integration within the cardio-cerebrovascular services pathway
DOI:
https://doi.org/10.17533/udea.rfnsp.e357617Keywords:
Patient-Centered Care, Continuity of Patient Care, Delivery of Health Care, cardio-cerebrovascular pathway, care pathway, instrument validation and testingAbstract
Objective: To develop an instrument to measure patient perceptions about integrated care in the cardio-cerebrovascular care pathway.
Methods: An instrument was designed after carrying out a systematic search and a free search in the literature to identify scales and surveys measuring patient perceptions about integrated health care. We selected items evaluating the construct of integration, applicable to the Colombian context and useful for quality improvement actions; and subsequently, an instrument was developed. An expert panel assessed the first version to analyze the validity of its contents. Some adjustments were made and a pilot test was carried out with 14 patients in order to assess the clarity and suitability of the items.
Results: The initial instrument included 18 items from 7 surveys and 10 new items developed by the researchers. The experts confirmed the validity of the instrument and suggested adjustments to the wording and response options to adapt it to the local context. The pilot test led to minor changes in the explanations and wording in response options. The final instrument included 28 Likert-type items.
Conclusion: An instrument was developed according to the international literature and adapted to the local context in order to measure patient perception about integrated care in the cardio-cerebrovascular care pathway.
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References
1. Ski CF, Cartledge S, Foldager D, et al. Integrated care in cardiovascular disease: A statement of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. Eur J Cardiovasc Nurs. 2023;22(5):e39-46. DOI: https://doi.org/10.1093/eurjcn/zvad009
2. Ferrari AJ, Santomauro DF, Aali A, et al. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet [internet]. 2024 [citado 2024 may. 5]; 403(10440):2133-61. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00757-8/fulltext
3. Colombia, Ministerio de Salud y Protección Social, Dirección de Epidemiología y Demografía. Análisis de situación de salud Colombia 2022 [internet]. Ministerio de Salud y Protección Social; 2023 [citado 2024 may. 5]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/asis-colombia-2022.pdf
4. Kern LM, Bynum JPW, Pincus HA. Care fragmentation, care continuity, and care coordination-how they differ and why it matters. JAMA Intern Med. 2024;184(3):236-7. DOI: https://doi.org/10.1001/jamainternmed.2023.7628
5. Bossert T, Bärnighausen T, Bowser D, et al. Assessing financing, education, management and policy context for strategic planning of human resources for health [internet]. 2007 [citado 2023 jul. 28]. Disponible en: https://iris.who.int/handle/10665/43780
6. Singer SJ, Friedberg MW, Kiang MV, et al. Development and preliminary validation of the Patient Perceptions of Integrated Care survey. Med Care Res Rev. 2013;70(2):143-64. https://doi.org/10.1177/1077558712465654
7. Prior A, Vestergaard CH, Vedsted P, et al. Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: A Danish nationwide cohort study. BMC Med. 2023;21(1):305. DOI: https://doi.org/10.1186/s12916-023-03021-3
8. Snow K, Galaviz K, Turbow S. Patient outcomes following interhospital care fragmentation: A systematic review. J Gen Intern Med. 2020;35(5):1550-8. DOI: https://doi.org/10.1007/s11606-019-05366-z
9. Colombia, Ministerio de Salud y Protección Social. Política de Atención Integral en Salud “Un sistema de salud al servicio de la gente” [internet]; 2016 [citado 2024 jul. 28]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/modelo-pais-2016.pdf
10. Colombia, Ministerio de Salud y Protección Social. Resolución 3202, por la cual se adopta el Manual metodológico para la elaboración e implementación de las rutas integrales de atención en salud — RIAS, se adopta un grupo de rutas integrales de atención en salud desarrolladas por el Ministerio de Salud y Protección Social dentro de la Política de Atención Integral en Salud —PAIS y se dictan otras disposiciones [internet]. (2016 jul. 25) [citado 2024 jul. 28]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3202-de-2016.pdf
11. Vergara M, Caballero A, Saavedra A, et al. Condiciones de salud para ajuste de riesgo de la UPC y mecanismo de incentivos para el mejoramiento de la calidad y los resultados en salud. Dirección de Regulación de Beneficios, Costos y Tarifas del Aseguramiento en Salud [internet]; 2022 [citado 2023 jul. 31]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VP/DOA/condiciones-salud-upc-incentivos-calidad-resultados-salud-2022.pdf
12. Díaz del Castillo A, Martínez L, Palacio D. Percepciones y experiencias de acceso a la ruta de atención integral cardio-cerebrovascular (RIA-CCV) por parte de pacientes con hipertensión arterial y diabetes afiliados a Capital Salud-EPS’s entre enero de 2019 y julio de 2020 en Bogotá: un estudio cualitativo exploratorio. Convenio interadministrativo 737-2019 entre el Fondo Financiero Distrital de Salud y la Universidad Nacional de Colombia. Noviembre 20, 2020.
13. Fondo Colombiano de Enfermedades de Alto Costo. Situación de la enfermedad renal crónica, la hipertensión arterial y la diabetes mellitus en Colombia 2019. [internet]. 2019 [citado 2023 jul. 28]. Disponible en: https://cuentadealtocosto.org/wp-content/uploads/2020/06/CAC.Co_2020_06_24_Libro_Sit_ERC_2019V7.pdf
14. Cuenta de Alto Costo. Situación de la enfermedad renal crónica, la hipertensión arterial y la diabetes mellitus en Colombia 2022 [internet]; 2023 [citado 2023 jul. 31]. Disponible en: https://cuentadealtocosto.org/publicaciones/situacion-de-la-enfermedad-renal-cronica-la-hipertension-arterial-y-la-diabetes-mellitus-en-colombia-2022/
15. Lin X, Xu Y, Pan X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. DOI: https://doi.org/10.1038/s41598-020-71908-9
16. García-Subirats I, Aller MB, et al. Adaptación y validación de la escala CCAENA© para evaluar la continuidad asistencial entre niveles de atención en Colombia y Brasil. Gac Sanit. 2015;29(2):88-96. DOI: https://doi.org/10.1016/j.gaceta.2014.10.009
17. Valderas JM, Porter I, Martin-Delgado J, et al. Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions. BMJ Qual Saf. 2024. DOI. https://doi.org/10.1136/bmjqs-2024-017301
18. Parra-Vega I, Marqués-Sánchez P, et al. Development and validation of a questionnaire for assessing patients´ perceptions of interprofessional integration in health care. J Interprof Care. 2022;36(4):538-44. DOI: https://doi.org/10.1080/13561820.2021.1900803
19. Podsakoff PM, MacKenzie SB, et al. Common method biases in behavioral research: A critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879-903. DOI: https://doi.org/10.1037/0021-9010.88.5.879
20. Clark LA y Watson D. Constructing validity: New developments in creating objective measuring instruments. Psychol Assess. 2019;31(12):1412-27. DOI: https://psycnet.apa.org/doi/10.1037/pas0000626
21. Boateng GO, Neilands TB, Frongillo EA, et al. Best practices for developing and validating scales for health, social, and behavioral research: A primer. Front Public Health. 2018;6:149. DOI: https://doi.org/10.3389/fpubh.2018.00149
22. EORTC Quality of Life. Module Development Guidelines (2021) [internet]; 2021 [citado 2024 nov. 11]. Disponible en: https://qol.eortc.org/manual/the-module-development-guidelines-2021/
23. Colombia, Ministerio de Salud. Resolución 8430, por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud [internet]. (1993 oct. 4) [citado 2024 jul. 17]. Disponible en: https://www.minsalud.gov.co/sites/rid/lists/bibliotecadigital/ride/de/dij/resolucion-8430-de-1993.pdf
24. Asociación Médica Mundial. Declaración de Helsinki de la Asamblea Médica Mundial – Principios éticos para las investigaciones médicas en seres humanos [internet]. 2024 [citado 2024 sep. 8]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
25. Schultz EM, Pineda N, Lonhart J, et al. A systematic review of the care coordination measurement landscape. BMC Health Serv Res. 2013;13(1):119. DOI: https://doi.org/10.1186/1472-6963-13-119
26. Bautista MAC, Nurjono M, Lim YW, et al. Instruments measuring integrated care: A systematic review of measurement properties. Milbank Q. 2016;94(4):862-917. DOI: https://doi.org/10.1111/1468-0009.12233
27. Uijen AA, Heinst CW, Schellevis FG, van den Bosch WJHM, van de Laar FA, Terwee CB, et al. Measurement properties of questionnaires measuring continuity of care: a systematic review. PloS One. 2012;7(7):e42256.
28. Black D, Held ML, et al. Measures evaluating patient satisfaction in integrated health care settings: A systematic review. Community Ment Health J. 2021;57(8):1464-77. DOI: https://doi.org/10.1007/s10597-020-00760-y
29. Pascual López JA, Gil Pérez T, et al. Cuestionarios de atención centrada en la persona en atención primaria. Una revisión sistemática. Aten Primaria. 2020;52(10):738-49. DOI: https://doi.org/10.1016/j.aprim.2019.11.004
30. Ball LE, Barnes KA, Crossland L, et al. Questionnaires that measure the quality of relationships between patients and primary care providers: A systematic review. BMC Health Serv Res. 2018;18(1):866. DOI: https://doi.org/10.1186/s12913-018-3687-4
31. Hudon C, Fortin M, Haggerty JL, et al. Measuring patients’ perceptions of patient-centered care: A systematic review of tools for family medicine. Ann Fam Med. 2011;9(2):155-64. DOI: https://doi.org/10.1370/afm.1226
32. Haggerty JL, Burge F, Pineault R, et al. Management Continuity from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthc Policy [internet]. 2011 [citado 2024 may. 6]; 7(Spec Issue):139-53. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC3399442/
33. Burge F, Haggerty JL, Pineault R, et al. Relational continuity from the patient perspective: Comparison of primary healthcare evaluation instruments. Healthc Policy [internet]. 2011 [citado 2024 may. 6]; 7(Spec Issue):124-38. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC3399435/
34. Haggerty JL, Roberge D, Freeman GK, et al. Validation of a generic measure of continuity of care: When patients encounter several clinicians. Ann Fam Med. 2012;10(5):443-51. DOI: https://doi.org/10.1370/afm.1378
35. Lyratzopoulos G, Elliott MN, Barbiere JM, et al. How can health care organizations be reliably compared?: Lessons from a national survey of patient experience. Med Care. 2011;49(8):724-33. DOI: https://doi.org/10.1097/mlr.0b013e31821b3482
36. Törő V, Kósa Z, Takács P, et al. Patients’ Assessment of Chronic Illness Care (PACIC): Validation and evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary. Int J Integr Care. 2022;22(3):5. DOI: https://doi.org/10.5334/ijic.6010
37. Ryan BL, Brown JB, et al. Measuring Patients’ perceptions of health care encounters: Examining the factor structure of the revised Patient Perception of Patient-Centeredness (PPPC-R) questionnaire. J Patient-Centered Res Rev. 2019;6(3):192-202. DOI: https://doi.org/10.17294/2330-0698.1696
38. Benachi Sandoval N, Castillo Martínez A, Vilaseca Llobet JM, et al. Validación de la versión en español del cuestionario PCAS para evaluar la atención primaria de salud. Rev Panam Salud Pública [internet]. 2012 [citado 2024 may. 6]; 31(1):32-9. Disponible en: https://iris.paho.org/handle/10665.2/9395
39. Gulliford M, Cowie L, Morgan M. Relational and management continuity survey in patients with multiple long-term conditions. J Health Serv Res Policy. 2011;16(2):67-74. DOI: https://doi.org/10.1258/jhsrp.2010.010015
40. Beaulieu MD, Haggerty JL, Beaulieu C, et al. Interpersonal communication from the patient perspective: Comparison of primary healthcare evaluation instruments. Healthc Policy [internet]. 2011 [citado 2024 may. 6]; 7(Spec Issue):108-23. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC3399440/
41. Kruk ME, Lewis TP. Introduction to The Lancet Global Health’s Series on the People’s Voice Survey on Health System Performance. Lancet Glob Health. 2024;12(1):e14-e15. DOI: https://doi.org/10.1016/s2214-109x(23)00512-0
42. Departamento Administrativo Nacional de Estadística. Metodología general Encuesta Nacional de Calidad de Vida [internet]. 2024 [citado 2024 may. 6]. Disponible en: https://www.dane.gov.co/files/operaciones/ECV/met-ECV-2024.pdf
43. Jebb AT, Ng V y Tay L. A Review of Key Likert Scale Development Advances: 1995-2019. Front Psychol. 2021;12:637547. DOI: https://doi.org/10.3389/fpsyg.2021.637547
44. Colombia, Ministerio de Salud. Colombia llegó al aseguramiento universal en salud al alcanzar el 99,6 %. Boletín de Prensa 373 [internet]. 2022 [citado 2024 may. 6]. Disponible en: https://www.minsalud.gov.co/Paginas/Colombia-llego-al-aseguramiento-universal-en-salud-al-alcanzar-el-99.6.aspx
45. Colombia, Congreso de la República. Ley Estatutaria 1751, por medio de la cual se regula el derecho fundamental a la salud y se dictan otras disposiciones [internet]; (2015 feb. 16) [citado 2024 may. 6]. Disponible en: http://www.secretariasenado.gov.co/senado/basedoc/ley_1751_2015.html
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