Development of a survey instrument to measure patient experiences of care transitions from hospital to home with a focus on primary care’s role

Background. Care transitions (CTs) from acute care to primary care are an important focus for improvement. Primary care plays a significant role in supporting successful CTs. However, there are few validated patient-reported experience measures (PREMs) on this topic. The purpose of this study is to develop a PREM to capture patients’ experiences of care while transitioning from acute to primary care. Methods. A preliminary instrument was developed through a literature review and concept mapping, followed by content validity testing with content experts (n = 6) by calculating item content validity index (I-CVI) scores and with patients (n = 6) by conducting cognitive interviews. The instrument was modified based on triangulation of results, then underwent a participant validation exercise (patients, n = 6) and formal health literacy review. Results. The literature review identified 13 potentially relevant PREM instruments, of which three addressed both CTs and primary care. None of the 3 instruments completely captured the concepts or time points of interest. The PREM developed for pre-testing contained 18 core items. All core items had I-CVI scores >0.78 (i.e., high relevance). Four broad themes were identified from the cognitive interviews: ‘Health Literacy’ ( n = 10), ‘Clarity of Terms’ ( n = 7), ‘Concept Measurement’ ( n = 2), and ‘Ability to Comment’ ( n = 4). Minor wording changes and clarification of definitions and instructions addressed most themes. All 18 core items met the criterion for agreement ( > 67%) during the participant validation exercise. Therefore, the final PREM instrument contains 18 core items plus 4 open-text options. The comparison of results from the participant validation exercise and health literacy review confirmed justification for revisions of instrument items. Conclusion. Developing this new PREM instrument which captures patient’ experiences as they move between acute and primary care, with a focus primary care’s supporting role is key to gaining understanding and improving CTs. Future research will further examine the psychometric properties of this PREM as part of a larger ongoing study.