Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire
Authors: Safstrom E , Arestedt K , Hadjistavropoulos H , Liljeroos M , Nordgren L , Jaarsma T , Stromberg A 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medical Research Council of Southeast Sweden.
Center for Clinical Research Sörmland/Uppsala University

Introduction
Hundreds of thousands of persons are discharged from hospitalisation due to cardiac diseases every year in Europe. Follow-up after hospitalisation due to cardiac diseases usually occurs with another healthcare provider, e.g., in primary care, which is a challenge for the coordination and continuity of care. Continuity of care after hospitalisation is an essential indicator of the quality of care, and international reports highlight the importance of improving continuity of care. Patients’ perception of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ-27 items). However, the length of the questionnaire represents a barrier to completion, and, therefore, we aimed to develop and psychometrically evaluate a short version of the PCCQ.

Method
This was a psychometric validation study. Content validity was first evaluated among user groups, including patients (n=7), health care professionals (n=15), and researchers (n=7). Then, based on content validity and conceptual discussions in the research group, 12 items were selected for the short version. Data were collected from patients six weeks after hospitalisation due to angina, atrial fibrillation, acute myocardial infarction, or heart failure using a consecutive sampling procedure. Measurement properties were evaluated with the Rasch Measurement Model.

Results
A total of 1000 patients were included (66% males, mean age 72 SD=10). The 12 items presented satisfactory overall model fit and a reliability of 0.79. Three items did not fit the model as they presented fit residuals &gt;±2.5. The items presenting misfit were: item 12 (information on treatment after discharge), item 28 (personnel had knowledge on medical situation) and item 29 (confidence in personnel) (Table 1).
Four items presented response dependence; a patients answer on item 2 (information on prognosis) seemed to depend on how the patient had answered item 1 (information on diagnosis). Also, items 28 and 29 seemed to be response dependent. Each pair of response-dependent items was combined into a larger subtest item to evaluate any impact on measurement properties. However, the changes in person location, person fit, and PSI were negligible, and no effect on the measurement properties or reliability was observed. Further, no evidence of multidimensionality was found, and a total score can be calculated.
The Rasch measurement model found the thresholds between the first two response options ‘strongly disagree’ and ‘somewhat disagree’ disordered in all items (Table 1). However, we found that amending the response options did not alter the prior results regarding response dependence, dimensionality, or reliability but improved individual fit residual for items 12, 27 and 28.

Conclusion
The PCCQ-12 is a short, unidimensional and psychometrically sound questionnaire ready to be used to measure the perception of continuity of care after hospitalisation.