Measuring care coordination in German primary care \u2013 adaptation and psychometric properties of the Medical Home Care Coordination Survey

Aleida Ringwald,Aleida Ringwald,Kristina Flaegel,Kristina Flaegel,Alexandra Schüssler,Nina Fleischmann,Jost Steinhaeuser,Jost Steinhaeuser,Katja Goetz,Katja Goetz

doi:10.1186/s12913-021-07100-0

Aleida Ringwald, Aleida Ringwald + Show 8 more

Open Access

https://doi.org/10.1186/s12913-021-07100-0

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Abstract

BackgroundContinuity of care is associated with many benefits for patients and health care systems. Therefore measuring care coordination - the deliberate organization of patient care activities between two or more participants - is especially needed to identify entries for improvement. The aim of this study was the translation and cultural adaptation of the Medical Home Care Coordination Survey (MHCCS) into German, and the examination of the psychometric properties of the resulting German versions of the MHCCS-P (patient version) and MHCCS-H (healthcare team version).MethodsWe conducted a paper-based, cross-sectional survey in primary care practices in three German federal states (Schleswig-Holstein, Hamburg, Baden-Württemberg) with patients and health care team members from May 2018 to April 2019. Descriptive item analysis, factor analysis, internal consistency and convergent, discriminant and predictive validity of the German instrument versions were calculated by using SPSS 25.0 (Inc., IBM).ResultsResponse rates were 43% (n = 350) for patients and 34% (n = 141) for healthcare team members. In total, 300 patient questionnaires and 140 team member questionnaires could be included into further analysis. Exploratory factor analyses resulted in three domains in the MHCCS-D-P and seven domains in the MHCCS-D-H: “link to community resources”, “communication”, “care transitions”, and additionally “self-management”, “accountability”, “information technology for quality assurance”, and “information technology supporting patient care” for the MHCCS-D-H. The domains showed acceptable and good internal consistency (α = 0.838 to α = 0.936 for the MHCCS-D-P and α = 0.680 to α = 0.819 for the MHCCS-D-H).As 77% of patients (n = 232) and 63% of health care team members denied to have or make written care plans, items regarding the “plan of care” of the original MHCCS have been removed from the MHCCS-D.ConclusionsThe German versions of the Medical Home Care Coordination Survey for patients and healthcare team members are reliable instruments in measuring the care coordination in German primary care practices. Practicability is high since the total number of items is low (9 for patients and 27 for team members).

Highlights

Continuity of care is associated with many benefits for patients and health care systems
Key feature is a team-based, patientcentered approach containing elements of the Patient-Centered Medical Home (PCMH) in order to resolve shortcomings of the German health care system that were all attributed to various coordination challenges [7]
The results were discussed during two consensus telephone meetings with other researchers in an interdisciplinary team of two physicians (JS, KF), a medical student (AR), a nursing scientist (NF) and a health scientist (AS) in order to reconcile the forward translations into a single forward translation of both the Medical Home Care Coordination Survey (MHCCS)-P and the MHCCS-H

Summary

Introduction

Continuity of care is associated with many benefits for patients and health care systems. Measuring care coordination - the deliberate organization of patient care activities between two or more participants - is especially needed to identify entries for improvement. Care coordination as one important aspect of continuity of care is defined as “the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. The Patient-Centered Medical Home (PCMH) as an example for a model of delivering primary care aspires to expand the existing primary health care in the following five functions: comprehensiveness of care, patientcentered health care, coordination of care, accessibility of services and quality and safety [3, 4]. In particular the exchange of relevant information about patients between primary care physicians and specialists and the information technology that facilitates care coordination with patients and other clinical providers have potential for improvement [8]

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