Validation and implementation of a patient-reported experience measure for patients with rheumatoid arthritis and spondyloarthritis in the Netherlands

Esther Beckers,Annelies Boonen,Peter M Ten Klooster,Casper Webers,Harald E Vonkeman,Astrid Van Tubergen

doi:10.1007/s10067-020-05076-6

Esther Beckers, Annelies Boonen + Show 4 more

Open Access

https://doi.org/10.1007/s10067-020-05076-6

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Abstract

ObjectivesTo test the psychometric properties of the United Kingdom’s Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and to implement this questionnaire in daily practice in the Netherlands.MethodsAfter a forward-backward translation procedure into Dutch, the CQRA-PREM was tested into two quality registries in daily practice. Face validity was assessed with focus group interviews. Feasibility was evaluated through completion times and interpretability of domain scores through floor and ceiling effects. Internal consistency (Cronbach’s α coefficients) and homogeneity (corrected item-total correlations) were determined. Divergent validity was assessed by Spearman’s rank correlation coefficients (rs) between the average scores of domains and outcome measures. The CQRA-PREM was implemented in daily practice, and the results were used in quality improvement cycles.ResultsFace validity of the CQRA-PREM was good. The CQRA-PREM was completed by 282 patients with SpA and 376 with RA. Median time to complete the CQRA-PREM was 4.7 min. Ceiling effects were found in three out of seven domains. Internal consistency of nearly all domains was considered good (0.65 ≤ α ≤ 0.95). Thresholds for homogeneity were exceeded within three domains (rp > 0.7), suggesting item redundancy. Divergent validity showed that nearly all domains of the CQRA-PREM were at most weakly correlated with outcomes measures (− 0.3 ≤ rs ≤ 0.3). The CQRA-PREM could identify areas of improvement for providing patient-centered care.ConclusionThe CQRA-PREM has acceptable psychometric properties and has shown to be a useful tool in evaluating quality of care from the patients’ perspective in the Netherlands.Trial registrationSpA-Net is registered in the Netherlands Trial Registry (NTR6740).Key Points• The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) is a valid measure for assessing patient-centeredness of rheumatology care.• The Dutch version of the CQRA-PREM shows acceptable psychometric properties.• The CQRA-PREM shows to be a useful tool in Plan-Do-Check-Act quality improvement cycles in the Netherlands.• The CQRA-PREM can be used for benchmarking and quality improvement of rheumatology services.

Highlights

Evaluating the quality of care provided is helpful to reveal areas of improvement of care, identify best practices and stimulate development and implementation of care innovations
The United Kingdom (UK) version of the CQRA-patient-reported experience measures (PREMs) was independently translated into Dutch by two native Dutch-speaking researchers fluent in English
The CQRA-PREM was completed by 282 patients with SpA and 376 patients with rheumatoid arthritis (RA)

Summary

Introduction

Evaluating the quality of care provided is helpful to reveal areas of improvement of care, identify best practices and stimulate development and implementation of care innovations. The Institute of Medicine (IOM) identifies six pillars for evaluating quality of care in the current health care system: care that is provided should be safe, effective, patient-centered, timely, efficient, and equitable [2]. Patient-centered care is defined by the IOM as care that is respectful of, and responsive to, individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions [2]. It is organized around the health needs and expectations of patients rather than around diseases

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