Chapter 5. Measure Maps and Profiles (continued, 11)

Measure #23. Program of All-Inclusive Care for the Elderly (PACE)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Program of All-Inclusive Care for the Elderly (PACE)

Purpose: To develop an instrument that will assess interdisciplinary team performance in a nursing home facility.

Format/Data Source: Self-administered, mailed surveys in several languages were implemented along with telephone support for survey-related questions. Responses were based on a 5-point Likert scale for all items in Section 1.

Date: Measure published in 2009.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Communicate:
  • Within teams of health care professionals: 1A7, 1A10, 1C8
  • Across health care teams or settings: 1C7
• Information transfer:
  • Within teams of health care professionals: 1B12
  • Across health care teams or settings: 1B13
  • Participants not specified: 1B15, 1C2
• Assess needs and goals: 1C8, 1D1, 1D5
• Create a proactive plan of care: 1A10, 1B10, 1C6, 1C8
• Monitor, follow up, and respond to change: 1C2
• Teamwork focused on coordination: 1C4, 1D7

Development and Testing: Instrument items were adapted from a previously validated PACE instrument, which was pilot tested via 3 approaches: (1) questions were reviewed by an education specialist and a specialist in English-as-a-second-language to confirm appropriateness; (2) an expert panel provided feedback, and (3) the instrument was pilot tested among 84 aides in either a PACE program or a nursing home. All domains demonstrate reliability, and regression analyses determined sufficient construct validity. Cronbach's alpha coefficients supported internal consistency reliability. Face validity was supported by the previous testing of the instrument, and content validity was determined by examining the relevance of the survey questions.^{1, 2}

Link to Outcomes or Health System Characteristics: None described in the sources identified.

Logic Model/Conceptual Framework: PACE stems from an adaptation of the model developed by Shortell and Rousseau to assess nurse-physician collaborative relationships within intensive care settings.²

Past or Validated Applications:

• Setting: Nursing home or residential facility in the United States
• Population: Elderly patients
• Level of evaluation: System

Notes:

• Instrument was provided by the corresponding author upon request (H. Temkin-Greener, personal communication, September 1, 2010).
• This instrument contains 86 items. Only Section 1 was mapped, which contains 46 items; 14 of which were mapped.

Sources:

1. Temkin-Greener H, Zheng N, Katz P, et al. Measuring work environment and performance in nursing homes. Med Care 2009;47(4):482-91.
2. Temkin-Greener H, Gross D, Kunitz SJ, et al. Measuring interdisciplinary team performance in a long-term care setting. Med Care 2004;42(5):472-81.
3. Temkin-Greener H, Cai S, Katz P, et al. Daily practice teams in nursing homes: Evidence from New York State. Gerontologist 2009;49(1):68-80.

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Measure #24. Measure of Processes of Care (MPOC-28)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Measure of Processes of Care (MPOC-28)

Purpose: To evaluate the quality of care during the habilitation process specific to children and adolescents.

Format/Data Source: Measurement of Processes of Care (MPOC) modified to MPOC-28 in a written survey (questionnaire). The 28-item questionnaire addresses the same 5 areas as the MPOC-20: (1) enabling and partnership, (2) general information, (3) specific information, (4) coordinated care and comprehensive care, and (5) respectful and supportive care. Habilitation is here described as, “a multifaceted service in which contributions are based on learning and experience from different areas, woven together in a complex network. Habilitation services are aimed at children with disabilities themselves, their families and at the network of people around the children. A fundamental factor in family-centered habilitation is that the interests of the child and family should guide the process both in assessing needs and in planning and carrying out the programme.”¹

Date: Measure published in 2002.¹

Perspective: Patient/Family

Measure Item Mapping:

• Communicate:
  • Between health care professional(s) and patient/family: 18, 19, 24
  • Across health care teams or settings: 28
• Information transfer:
  • Between health care professional(s) and patient/family: 6, 8, 9, 20
• Facilitate transitions:
  • As coordination needs change: 26
• Assess needs and goals: 2-4, 6, 19
• Create a proactive plan of care: 10, 22
• Monitor, follow up, and respond to change: 5, 26
• Support self-management goals: 12-15, 27
• Link to community resources: 11, 15
• Teamwork focused on coordination: 22, 25, 28

Development and Testing: This instrument was developed and tested in a previous article in reference to a longer version of the instrument, MPOC-56. Construct validity and significance were demonstrated and questions were grouped via five factors: (1) enabling and partnership, (2) general information, (3) specific information, (4) coordinated and comprehensive care, and (5) respectful and supportive care. Differences were compared, applied, and addressed concerning scales between MPOCs. Test-retest reliability with Cronbach's alpha coefficients, intra-class correlation coefficients, and construct validation were all successfully demonstrated. Internal consistency was confirmed in pilot testing and beyond, while validity was supported by factor analysis.²

Link to Outcomes or Health System Characteristics: None described in the sources identified.

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: Primary care settings in Sweden
• Population: Children with disabilities
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located in Appendix 1 of the source article.¹
• This instrument contains 28 items; 22 were mapped.
• 2 other versions are available: (1) MPOC-56 and (2) MPOC-20.³ Testing information on the MPOC-56 is also provided by King.²

Sources:

1. Granat T, Lagander B, Borjesson MC. Parental participation in the habilitation process: Evaluation from a user perspective. Child Care Health Dev 2002;28(6):459-67.
2. King SM, Rosenbaum PL, King GA. Parents' perceptions of care giving: development and validation of a measure of processes. Dev Med Child Neurol 1996;38:757-72.
3. McMaster University Measure of Processes of Care (MPOC) Web site. Available at: http://www.canchild.ca/en/measures/mpoc56_mpoc20.asp. Accessed: 20 September 2010.

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Measure #25. Care Evaluation Scale for End-of-Life Care (CES)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Care Evaluation Scale for End-of-Life Care (CES)

Purpose: To develop an instrument that measures the perceptions of palliative and/or end-of-life care from the perspective of the bereaved family.

Format/Data Source: 28-item questionnaire mailed to bereaved families who had a patient in palliative, end-of-life care. 10 subscales cover: (1) physical care by physicians, (2) physical care by nurses, (3) psycho-existential care, (4) help with decisionmaking for patients, (5) help with decisionmaking for family, (6) environment, (7) family burden, (8) cost, (9) availability, and (10) coordination and consistency. Responses were structured on a 6-point Likert scale.

Date: Measure published in 2004.¹

Perspective: Patient/Family

Measure Item Mapping:

• Communicate:
  • Between health care professional(s) and patient/family: 10, 11, 13-15
• Assess needs and goals: 9, 12, 28
• Monitor, follow up, and respond to change: 28
• Support self-management goals: 12
• Teamwork focused on coordination: 26, 27

Development and Testing: The CES instrument, originally 67 items, was pilot tested and revised to 28 items. Questions were developed from the Sat-Fam-IPC scale and revised after pilot testing and after receipt of written survey comments. Instrument originally in Japanese and translated through a double back-translation to English. It successfully measures aspects of palliative care and areas for improvement through demonstration of a valid Cronbach's alpha coefficient of 0.98 and an intra-class correlation coefficient in the test-retest examination of 0.57. Confirmatory factor analysis was examined and supported construct validity. Convergent and discriminant validity were calculated through correlation coefficients between the CES subscale scores and the perceived experience, yielding satisfactory results. Pearson's correlation coefficients between subscale scores established social desirability of the CES.¹

Link to Outcomes or Health System Characteristics: None described in the sources identified.

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: End-of-life palliative care in Japan (70 certified facilities)
• Population: Families of patients with palliative or end-of-life care
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located in the Appendix of the source article.¹
• This instrument contains 28 items; 12 were mapped.

Sources:

1. Morita T, Hirai K, Sakaguchi Y, et al. Measuring the quality of structure and process in end-of-life care from the bereaved family perspective. J Pain Symptom Manage 2004;27(6):492-501.

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Measure #26. Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS)

Purpose: To develop and test the Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS).

Format/Data Source: 112 initial items within 8 subscales were developed with 59 items achieving content validity from an expert panel review and 41 items comprising the long version. The 8 subscales included: (1) professional knowledge (8 items), (2) continuity (1 item), (3) attentiveness (10 items), (4) coordination (9 items), (5) partnership (8 items), (6) individualization (9 items), (7) rapport (3 items), and (8) caring (11 items). Response provided on 4 – 6 point Likert scales.

Date: Measure published in 2003.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 36, 40
• Communicate:
  • Between health care professional(s) and patient/family: 5, 25, 40
• Information transfer:
  • Between health care professional(s) and patient/family: 34
• Facilitate transitions:
  • Across settings: 38
• Assess needs and goals: 17, 26, 33, 35
• Monitor, follow up, and respond to change: 14
• Support self-management goals: 11, 34

Development and Testing: Content validity achieved through an expert panel review. Construct validity examined using exploratory factor analysis, and internal consistency reliability determined using Cronbach's alpha coefficient. All 41 items of the long version were analyzed using PCA and promax rotation, and 40 items met all criteria. Internal consistency reliability and convergent validity were assessed for each scale. Cronbach's alpha coefficients ranged from 0.82 – 0.97. Pearson product-moment correlation coefficients demonstrate strong, positive correlations as well.² Further testing information is available.¹

Link to Outcomes or Health System Characteristics: One study concludes that patients who receive greater patient-centered nursing interventions are far more likely to exhibit desired health outcomes, which contribute to quality of life.³

Logic Model/Conceptual Framework: The Quality Health Outcomes Model (QHOM) framed the development of several studies surrounding interventions and outcomes linked to the OPPQNCS.³

Past or Validated Applications:

• Setting: Oncology (inpatient) departments in the United States
• Population: Patients with cancer
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located online.⁴
• This instrument contains 41 items; 13 were mapped.
• An OPPQNCS short version (18-items) is also available online.⁴

Sources:

1. Radwin LE, Alster K, Rubin KM. Development and testing of the oncology patients' perceptions of the quality of nursing care scale. Oncol Nurs Forum 2003;30(2):283-90.
2. Suhonen R, Schmidt LA, Radwin LE. Measuring individualized nursing care: Assessment of reliability and validity of three scales. J Adv Nurs 2007;59(1):77-85.
3. Radwin LE, Cabral HJ, Wilkes G. Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system. Res Nurs Health 2009;32:4-17.
4. Massachusetts General Hospital Patient Care Services Web site. Available at: http://www2.massgeneral.org/pcs/the_institute_for_patient_care/ym/Tools/OPPQNCS.asp. Accessed: 16 September 2010.