Validation and implementation of a patient-reported experience measure for patients with rheumatoid arthritis and spondyloarthritis in the Netherlands

Abstract

Objectives To test the psychometric properties of the United Kingdom’s Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and to implement this questionnaire in daily practice in the Netherlands. Methods After a forward-backward translation procedure into Dutch, the CQRA-PREM was tested into two quality registries in daily practice. Face validity was assessed with focus group interviews. Feasibility was evaluated through completion times and interpretability of domain scores through floor and ceiling effects. Internal consistency (Cronbach’s α coefficients) and homogeneity (corrected item-total correlations) were determined. Divergent validity was assessed by Spearman’s rank correlation coefficients (rs) between the average scores of domains and outcome measures. The CQRA-PREM was implemented in daily practice, and the results were used in quality improvement cycles. Results Face validity of the CQRA-PREM was good. The CQRA-PREM was completed by 282 patients with SpA and 376 with RA. Median time to complete the CQRA-PREM was 4.7 min. Ceiling effects were found in three out of seven domains. Internal consistency of nearly all domains was considered good (0.65 ≤ α ≤ 0.95). Thresholds for homogeneity were exceeded within three domains (rp > 0.7), suggesting item redundancy. Divergent validity showed that nearly all domains of the CQRA-PREM were at most weakly correlated with outcomes measures (− 0.3 ≤ rs ≤ 0.3). The CQRA-PREM could identify areas of improvement for providing patient-centered care. Conclusion The CQRA-PREM has acceptable psychometric properties and has shown to be a useful tool in evaluating quality of care from the patients’ perspective in the Netherlands. Trial registration SpA-Net is registered in the Netherlands Trial Registry (NTR6740). Key Points • The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) is a valid measure for assessing patient-centeredness of rheumatology care. • The Dutch version of the CQRA-PREM shows acceptable psychometric properties. • The CQRA-PREM shows to be a useful tool in Plan-Do-Check-Act quality improvement cycles in the Netherlands. • The CQRA-PREM can be used for benchmarking and quality improvement of rheumatology services.

Effectiveness and cost-effectiveness of combined asynchronous telemonitoring and patient-initiated care for spondyloarthritis: protocol for a pragmatic multicentre randomised controlled trial (TeleSpA Study)

“…In SpA-Net, multiple variables are routinely measured in regular care ( table 1 ). Additionally for the TeleSpA Study, all included patients will complete questionnaires on whether their symptom state is acceptable, 46 experience with care (patient-reported experience measure (PREM), assessing overall experience with care and specific aspects including timeliness, emotional support, patient-centredness and safety), 47 a Self-Management Screening (SeMaS), 48 and questionnaires on health resource utilisation, work productivity, unpaid productivity loss, medication adherence, disease flares (self-reported) and experience with SpA-Net (general satisfaction, ease of use, added value) (see online supplemental file 1 ).…”

“…To evaluate quality of care, the dimensions ‘timely care’ (time to care when having a flare) and ‘patient-centredness’ will be operationalised by the PREM. 47 ‘Patient safety’ is evaluated through the number of complications and side-effects during follow-up. ‘Effectiveness of care’ is evaluated with measures of disease activity, functioning and health-related quality of life, and ‘efficiency of care’ through the number of rheumatology outpatient visits per year and a health economic analysis.…”

Portuguese adaptation and validation of a patient-reported experience measure for patients with rheumatoid arthritis: A protocol study

“…8 CQRA-PREM presents good construct validity and good internal consistency 8 and has been recently validated in Dutch. 9 This PREM might be feasible to routinely assess the experience of patients with RA in Portuguese clinical practice, yet an adaptation and validation process is first needed. Therefore, the main aims of this study will be to (1) translate and cross-culturally adapt the Portuguese version of CQRA-PREM, (2) evaluate its content and face validity through a qualitative approach, and (3) evaluate its psychometric properties through a clinical field testing.…”

“…5,6 Specifically in patients with RA, patient-centered care has been associated with clinical safety, improved effectiveness, and experienced care. 7–9…”

“…8 CQRA-PREM presents good construct validity and good internal consistency 8 and has been recently validated in Dutch. 9 This PREM might be feasible to routinely assess the experience of patients with RA in Portuguese clinical practice, yet an adaptation and validation process is first needed.…”