Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project

Schulze, J.; Glassen, Katharina; Pohontsch, Nadine Janis; Blozik, Eva; Eißing, Tabea; Breckner, Amanda; Höflich, Charlotte; Rakebrandt, Anja; Schäfer, Ingmar; Szécsényi, Joachim; Scherer, Martin; Lühmann, Dagmar

doi:10.1093/geront/gnac013

Cited by 6 publications

(17 citation statements)

References 49 publications

(50 reference statements)

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“…Following the Guidelines for Translating and Adapting Tests by the International Test Commission [ 23 ], we used a multiple step translation process and conducted cognitive interviews as well as a pilot test. Psychometric properties of the questionnaire were determined in a sub-study of the MULTIqual project [ 24 ], which included a sample of 346 older adults (65 years and older) with three or more long-term conditions.…”

Section: Methodsmentioning

confidence: 99%

“…We recruited patients (aged 65 and over) with multimorbidity from GP practices as part of the cross-sectional MULTIqual study on quality of care for older patients with multimorbidity [ 24 , 28 ]. GP practices in North and South Germany (Hamburg and Heidelberg and surroundings) were randomly selected, stratified by region, and invited to take part in the study.…”

Section: Methodsmentioning

confidence: 99%

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Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire

Schulze

Breckner

Duncan

et al. 2022

Health Qual Life Outcomes

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Background Patients with multiple long-term conditions often face a variety of challenges arising from the requirements of their health care. Knowledge of perceived treatment burden is crucial for optimizing treatment. In this study, we aimed to create a German version of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and to evaluate its validity. Methods The steps to translate the MTBQ included forward/back translation, cognitive interviews (n = 6) and a pilot test (n = 7). Psychometric properties of the scale were assessed in a cross-sectional survey with primary care patients aged 65 and older with at least 3 long-term conditions (n = 344). We examined the distribution of responses, dimensionality, internal reliability and construct validity. Results Cognitive interviewing and piloting led to minor modifications and showed overall good face validity and acceptability. As expected, we observed a positively skewed response distribution for all items. Reliability was acceptable with McDonald’s omega = 0.71. Factor analysis suggested one common factor while model fit indices were inconclusive. Predefined hypotheses regarding the construct validity were supported by negative associations between treatment burden and health-related quality of life, self-rated health, social support, patient activation and medication adherence, and positive associations between treatment burden and number of comorbidities. Treatment burden was found to be higher in female participants (Mdn1 = 6.82, Mdn2 = 4.55; U = 11,729, p = 0.001) and participants with mental health diagnoses (Mdn1 = 9.10, Mdn2 = 4.55; U = 3172, p = 0.024). Conclusions The German MTBQ exhibited good psychometric properties and can be used to assess the perceived treatment burden of patients with multimorbidity.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire

Schulze

Breckner

Duncan

et al. 2022

Health Qual Life Outcomes

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“…Data were collected as part of the project Development and Validation of Quality Indicators for Multimorbidity (MULTIqual), which aims at developing a set of indicators for primary care providers for patients with multimorbidity. 34 35 …”

Section: Methodsmentioning

confidence: 99%

“…They are suggested as indicators for the quality of care for patients with multimorbidity and could be used as measures to establish specific quality improvements. 34 35 Domains of care covered were as follows: (1) preferences in treatment (2) treatment goals, (3) involvement in treatment, (4) patient training programme (5) support group (6) self-management plan, (7) medication plan, (8) review on medication, (9) information on medication and (10) discussion about their treatment burden. The questions had mostly three response options (yes, no and I do not kno w ).…”

Section: Methodsmentioning

confidence: 99%

Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

et al. 2022

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ObjectivesThis study aimed to explore the association between patient activation and patients’ experience of care among an elderly multimorbid population in Germany.DesignCross-sectional study.SettingPrimary care practices in two German settings.Participants346 patients with 3 or more chronic conditions aged 65 years and over from 36 primary care practices.Outcome measuresPatient activation was measured with the patient activation measure (PAM). To assess patient experiences with primary care, a set of questions concerning domains of primary care were included. Multilevel regression analyses were performed to examine which domains of care were associated with patient activation.ResultsOut of 1243 invited patients, a total of 346 took part in the study (participation rate 27.8 %). Mean PAM score was 76.1. Across all patients, 3.8% achieved PAM level 1, 7.5% level 2, 27.2% level 3% and 60.7% level 4. PAM scores suggest a highly activated patient group. In the regression analysis, three out ten domains of patients’ experiences showed an association with patient activation. The domains ‘being involved in decision as much as desired’ (B=−8.56, p=0.012) and ‘receiving a self-management plan’ (B=6.51, p=0.051) were associated with higher patient activation scores. Patients with an up-to-date medication plan had lower patient activation scores (B=−12.01, p=0.041).ConclusionSpecific domains of primary care were found to be associated with patient activation. To enhance patient activation, primary care physicians may increase involvement of patients in decisions. Future research should examine the causality of these associations.Trial registration numberDRKS00015718.

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“…Subsequently, a multidisciplinary expert panel had rated these indicators in the dimensions significance, strength of evidence, possibility to influence the indicator manifestation and clarity of definition. Using nominal group technique, the expert panel then selected a set of 24 quality indicators from general practitioner (GP) perspective and 14 quality indicators from patient perspective and defined a conceptual framework that mapped the indicators to quality dimensions [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of patient- and GP-reported core sets of quality indicators for older adults with multimorbidity in primary care: results of the cross-sectional observational MULTIqual validation study

Schäfer

Schulze

Glassen

et al. 2023

BMC Med

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Background Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. Methods In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. Results Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (− 1.04, 95% CI = − 2.00/ − 0.08, p = 0.033) and had higher health-related quality of life (− 1.37, 95% CI = − 2.39/ − 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p < 0.001) were more likely to have lower GP-reported healthcare quality scores. Patients who had fewer GP contacts (0.12, 95% CI = 0.04/0.20, p = 0.002) and were less willing to use their GP to coordinate their care (0.16, 95% CI = 0.10/0.21, p < 0.001) were more likely to have lower patient-reported healthcare quality scores. Conclusions The quality indicator core sets are the first brief measurement tools specifically designed to assess quality of care for patients with multimorbidity. The indicators can facilitate implementation of treatment standards and offer viable alternatives to the current practice of combining disease-related metrics with poor applicability to patients with multimorbidity.

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Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project

Cited by 6 publications

References 49 publications

Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire

Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire

Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

Validation of patient- and GP-reported core sets of quality indicators for older adults with multimorbidity in primary care: results of the cross-sectional observational MULTIqual validation study

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