Through the patients’ eyes - Psychometric evaluation of the 64-item version of the Experienced Patient-Centeredness Questionnaire (EPAT-64)
Authors: Christalle Eva , Zeh Stefan , Führes Hannah , Schellhorn Alica , Hahlweg Pola , Zill Jördis , Härter Martin , Bokemeyer Carsten , Gallinat Jürgen , Gebhardt Christoffer , Magnussen Christina , Müller Volkmar , Schmalstieg-Bahr Katharina , Strahl André , Kriston Levente , Scholl Isabelle 
Published: March 2024

Background

Patient-reported experience measures (PREMs) are valuable tools for evaluating patient-centeredness (PC) from the patients’ perspective. Despite their utility, a comprehensive PREM addressing PC has been lacking. To bridge this gap, we developed the preliminary version of the Experienced Patient-Centeredness Questionnaire (EPAT), a disease-generic tool based on the integrative model of PC comprising 16 dimensions. It demonstrated content validity. The aim of this study was to test its psychometric properties and to develop a final 64-items version (EPAT-64).

Methods

In this cross-sectional study, we included adult patients treated for cardiovascular diseases, cancer, musculoskeletal diseases, and mental disorders in inpatient or outpatient settings in Germany. For each dimension of PC, we selected four items based on item characteristics such as item difficulty and corrected item-total correlation. We tested structural validity using confirmatory factor analysis, examined reliability by McDondald’s Omega, and tested construct validity by examining correlations with general health status and satisfaction with care.

Results

Analysis of data from 2.024 patients showed excellent acceptance and acceptable item-total-correlations for all EPAT-64 items, with few items demonstrating ceiling effects. The confirmatory factor analysis indicated the best fit of a bifactor model, where each item loaded on both a general factor and a dimension-specific factor. Omega showed high reliability for the general factor while varying for specific dimensions. Construct validity was confirmed by absence of strong correlations with general health status and a strong correlation of the general factor with satisfaction with care.

Conclusions

The EPAT-64 demonstrated commendable psychometric properties. This tool allows comprehensive assessment of PC, offering flexibility to users who can measure each dimension with a 4-item module or choose modules based on their needs. The EPAT-64 serves multiple purposes, including quality improvement initiatives and evaluation of interventions aiming to enhance PC. Its versatility empowers users in diverse healthcare settings.

What is already known on this topic

Patient-reported experience measures (PREMs) can be used to assess patient-centeredness (PC) from the patients’ perspective. The “Experienced Patient-Centeredness Questionnaire” (EPAT) is the first PREM to comprehensively assess 16 dimensions of PC.

What this study adds

In this study, we tested the psychometric properties of all items developed for the EPAT and developed the 64-item version of the EPAT (EPAT-64), which demonstrated good psychometric properties.

How this study might affect research, practice or policy

The EPAT-64 can be used in research and routine care, e.g. to evaluate interventions, provide feedback to healthcare professionals, support quality improvement, set benchmarks, and, consequently improve PC.