Development and psychometric assessment of a survey to measure specialty care coordination as experienced by primary care providers.

Abstract

To assess the psychometric properties and construct validity of a survey of primary care providers' (PCPs') experience of specialty care coordination, which is a counterpart to our existing survey ("CSC-Specialist") that measures specialists' experience of specialty care coordination. We surveyed PCPs from Veterans Health Administration medical centers and community-based outpatient clinics nationwide (N=1576) in April 2018. We developed candidate items through literature review, existing surveys, PCP interviews, and expert opinion. We used exploratory and confirmatory factor analysis to develop scales and multivariable linear regression to determine their association with PCPs' overall experience of coordination. The online survey included 23 candidate scale items about specialty care coordination and a single item asking respondents to rate their overall experience of specialty care coordination on a 0-10 scale. All VA PCPs were eligible. We sent survey invitations to PCPs following local Section Chiefs' email introduction (N=926) and by directly emailing two random samples (N=400 and N=6653), overall response rate across the three nonoverlapping samples=24 percent. Analyses identified 20 items forming 6 scales with strong psychometric properties and predictive power for overall coordination. Two scales are identical to CSC-Specialist scales: "Communication" (k=3, α=0.87) and "Data Transfer" (k=2, α=0.92); one is similar: "Relationships and Collaboration" (k=6, α=0.90). The three remaining scales address the PCP's unique perspective: "Role Clarity" (k=3, α=0.85), "Role Agreement" (k=3, α=0.75), and "Making Referrals" (k=3, α=0.75). The six scales together explained 67 percent of the variance in PCPs' overall coordination experience with specialists. The Coordination of Specialty Care-Primary Care Provider Survey (CSC-PCP) is a novel 20-item survey that can be used in quality improvement or health services research, alone or in combination with the CSC-Specialist, to evaluate coordination of care as experienced by either or both participants.