The use of cognitive interviews to revise the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM)
The “Quality of Trauma Care Patient-Reported Experience Measure” is the first measure of patient experiences with overall injury care. The objective of this study was to use cognitive interviews to inform revision of the measure into a parsimonious set of items that function as intended, in preparation for multicenter testing.
Concurrent and retrospective cognitive interviews with injured patients (n = 17) and family members (n = 13) using semi-structured interview guides. Responses were analyzed using thematic analysis.
Six broad themes were identified and guided revisions: (1) participants did not have the information to answer items (n = 9); (2) items were ambiguous or were inconsistently interpreted (n = 13); (3) items did not measure the intended constructs (n = 6); (4) items included assumptions about healthcare processes (n = 4); (5) items measured non-priority aspects of injury care (n = 8); and (6) items were redundant (n = 5). Two issues resulted in key conceptual and content changes: participants’ difficulty to evaluate pre-hospital, emergency department, and intensive care unit services due to recall issues and the challenge to evaluate the effectiveness and equity of care. In total, 39 items were deleted, 28 new items developed, and the final instrument included 63 items.
Our results informed changes to item content, format, and response options. This study highlights key issues to consider when incorporating patient/family perspectives into quality measurement, most notably, that few participants can assess the quality of care in the pre-hospital and emergency department phases of care and that novel methods are needed to evaluate the effectiveness and equity of care.
KeywordsCognitive interviews Measure development Patient experience Injury care
The project was supported by a Partnership in Health System Improvement Grant (PHE-238551) from the Canadian Institutes of Health Research and Alberta Innovates. Nik Bobrovitz was supported by a Health Quality Council of Alberta Studentship and an Alberta Innovates Health Solutions Studentship. Dr. Stelfox was supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates. Funding sources had no role in the design of this study and had no role in the conduct or reporting of this study.
Conflict of interest
We are unaware of any conflicts of interest. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study.
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