Evaluating Patient Experience in a Rural-Serving Nephrology Clinic: Psychometric assessment of the consideRATE questions and assessment of care experience
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Background
The illness experiences of people with kidney disease are not systematically ascertained as part of clinical care. We conducted the first real-world psychometric evaluation of the conside RATE questions among patients with kidney disease and assessed healthcare experiences in a rural hospital setting.
Methods
We conducted a cross-sectional survey with a sample of patients with kidney disease and their care partners. Our survey consisted of demographic questions, conside RATE (8-items) to measure healthcare experience, and CANHELP-Lite (21-items) as a reference for conside RATE psychometric assessment. We scored conside RATE as continuous (range: 1-4) and top-box (score=4). We conducted internal reliability (Cronbach’s alpha) and validity (convergent and discriminant using Pearson’s correlation) tests. We compared mean conside RATE scores between paired subgroups using t-tests. We examined the relationship between rurality and healthcare experience using a multivariable linear regression model and rural-urban commuting area codes.
Results
We recruited 163 participants, including 52 who lived in rural areas. The mean conside RATE score was 3.65 (SD=0.42), and the top-box score was 35% (n=59). Internal consistency for conside RATE was 0.86. We demonstrated convergent validity (continuous: r=0.5, p<0.001 and top-box: r=0.3, p<0.001) and discriminant validity (continuous: r=0.1, p>0.05 and top-box: r=0.1, p>0.05). Subgroup analyses revealed no significant differences in overall conside RATE scores by rurality status, state of residence, travel time, and gender. After adjustment for demographics, lower continuous mean conside RATE scores were significantly associated with longer travel time to the clinic (p<0.01), religious affiliation (p<0.05), and age over 55 years (p<0.01). We found no significant association between total conside RATE score and rurality.
Conclusion
We found validity in the first real-world psychometric assessment of conside RATE among people with kidney disease and found associations between healthcare experience and various demographic variables.
