Measuring Patient Safety in Primary Care: The Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC)

Abstract

PURPOSEWe set out to develop and validate a patient-reported instrument for measuring experiences and outcomes related to patient safety in primary care. METHODThe instrument was developed in a multistage process supported by an international expert panel and informed by a systematic review of instruments, a meta-synthesis of qualitative studies, 4 patient focus groups, 18 cognitive interviews, and a pilot study. The trial version of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) covered 5 domains and 11 scales: practice activation (1 scale); patient activation (1 scale); experiences of patient safety events (1 scale); harm (6 scales); and general perceptions of patient safety (2 scales). The questionnaire was posted to 6,736 patients in 45 practices across England. We used "gold standard" psychometric methods to evaluate its acceptability, reliability, structural and construct validity, and ability to discriminate among practices.RESULTS 1,244 completed questionnaires (18.5%) were returned. Median itemspecific response rate was 91.3% (interquartile range 28.0%). No major ceiling or floor effects were observed. All 6 multi-item scales showed high internal consistency (Cronbach's α 0.75-0.96). Factor analysis, correlation between scales, and known group analyses generally supported structural and construct validity. The scales demonstrated a heterogeneous ability to discriminate between practices. The final version of PREOS-PC consisted of 5 domains, 8 scales, and 58 items.CONCLUSIONS PREOS-PC is a new multi-dimensional patient safety instrument for primary care developed with experts and patients. Initial testing shows its potential for use in primary care, and future developments will further address its use in actual clinical practice. Ann Fam Med 2016;14:253-261. doi: 10.1370/afm.1935. INTRODUCTIONP atient safety, defined by the World Health Organization as "the prevention of errors and adverse effects to patients associated with health care," 1 is a growing interest in primary care systems. 2 Despite the potential impact on population health, major gaps remain in our understanding of primary care patient safety, particularly due to the lack of appropriate measurement methods, 2 which limits our ability to obtain reliable and repeatable rates of events for safety improvement and for research to identify fundamental underlying causes and mechanisms.Current tools rely almost exclusively on information supplied by health care providers (eg, safety culture questionnaires and voluntary reporting of safety events).3 A growing body of evidence, however, suggests that patients are sensitive to and able to recognize a range of problems in health care delivery 4,5 that are not identified by traditional systems of health care monitoring. 6,7 Patient reports constitute a reliable source of information 8,9 and have potential to improve the systematic detection of problems in health care. 254Our recent systematic review of primary care patient-reported safety measures showed that s...

Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach

“…Data on patient-reported patient safety measures and on patient characteristics were obtained using a cross-sectional survey 18. The survey was sent in June 2014 to a computer-generated random sample of 150 registered patients (18 years old or older) at each participating practice with a covering letter and a prepaid return envelope.…”

“…Ethical approval was granted by Nottingham Research Ethics Committee (Reference 13/EM/0258; July 2013). The survey included the PREOS-PC questionnaire,18 the EuroQOL 5D-5L19 and questions about patient sociodemographic and clinical characteristics described in more detail below.…”

“…We measured these with relevant scales from the PREOS-PC instrument relating to patient perceptions and experiences of the safety of their primary healthcare over the past 12 months. Details of the three scales are provided in online supplementary appendix 1 18. In short, experiences of safety problems were measured with an 11-item scale (Cronbach’s α=0.75) capturing information about whether or not the patients experienced specific types of safety problems (response categories being ‘No’, ‘Only once’, ‘Yes, more than once’).…”

“…Some studies have been based on patient-reported information, but were limited by the lack of valid and reliable patient-centred instruments to capture patients’ experiences and outcomes of patient safety 17. A patient-centred tool to measure patient safety in general practices — the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) — has been recently developed and validated 18. It allows for a comprehensive assessment of patient perceptions, experiences and outcomes of patient safety in primary care.…”

In This Issue: Decisions, Decisions

“…8 An impressively multi-method, multi-perspective study by Valderas et al develops and validates a new measure of Patient Reported Experiences and Outcomes of Safety in Primary Care. 9 This tool opens up new possibilities for practice improvement and research.…”