Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure?
Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure?
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DOI：
10.1161/jaha.114.001053
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发表时间：
2014-06-04
影响因子：
5.4
通讯作者：
Allison JJ
中科院分区：
文献类型：
--
作者：
Anatchkova MD;Barysauskas CM;Kinney RL;Kiefe CI;Ash AS;Lombardini L;Allison JJ
过渡性护理的质量与重要的健康结果有关，如再住院和费用。广泛使用的护理转变测量（CTM-15）是用经典的测试理论方法开发的;其简短版本（CTM-3）被纳入CAHPS医院调查。我们对这两种方法进行了心理测量学评估，并探讨项目反应理论（IRT）是否可以产生更精确的测量。作为冠状动脉事件结局研究和教育中心的转变、风险和行动的一部分，在急性冠状动脉综合征住院期间采访了1545名参与者，提供出院后1个月的一般健康状况（简表-36）、CTM-15、健康利用和护理过程问题的信息。我们使用经典和IRT分析，并使用相对效度比较了CTM-15-、CTM-3-和CTM-IRT评分的测量精度。参与者中79%为非西班牙裔白色人，67%为男性，平均年龄为62岁。CTM-15具有良好的内部一致性（Cronbach α=0.95），但表现出默许偏倚（8.7%的参与者对所有项目回答“非常同意”，19%回答“同意”）和有限的评分变异性。这些问题在CTM-3中更为明显。CTM-15根据自我报告的健康状况、医疗保健利用和护理过渡过程指标对患者组进行了区分。组间差异较小（2 - 3分）。IRT评分的测量精度没有增加。报告再次住院或急诊就诊的患者的CTM-3没有显著降低。我们确定了CTM的心理测量挑战，这可能会限制其在研究和实践中的价值。这些结果符合新出现的证据，表明该措施的有效性存在差距。
The quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM‐15) was developed with a classic test theory approach; its short version (CTM‐3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure. As part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form‐36), CTM‐15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM‐15–, CTM‐3–, and CTM‐IRT–based score using relative validity. Participants were 79% non‐Hispanic white and 67% male, with an average age of 62 years. The CTM‐15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded “Strongly agree” and 19% responded “Agree” to all items) and limited score variability. These problems were more pronounced for the CTM‐3. The CTM‐15 differentiated between patient groups defined by self‐reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM‐3 was not significantly lower for patients reporting rehospitalization or emergency department visits. We identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.