Validation of an instrument to measure inter-organisational linkages in general practice

Abstract

PurposeLinkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease.MethodsAn interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models.ResultsThe resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice.ConclusionsThe GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

“…Most instruments are questionnaires and were created or tested in a health care setting or with health-related outcomes. Intersectoral coordination is captured by variables such as: connections between partnering organizations [47484950]; social networks [5152]; interagency linkages [53545556]; depth of integration [5758]; and level of system integration and change [59]. Morrissey et al 1994 [51] developed two instruments appropriate for this domain.…”

Evaluating intersectoral collaboration: a model for assessment by service users

“…Instead, research and development has concentrated on specific models evaluating different aspects of collaboration from different perspectives. There are, for example, models assessing structural integration [4, 5] as well as functional integration [6, 7]. There are also models assessing integration effects on outcomes [8, 9].…”

Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: A multilevel study

“…The logistic (standard) distribution has variance 2 /3 = 3.29 and consequently this can be taken as the level 1 variance. The following formula was used: ICC = (level 2 variance)/(level 2 variance + 3.29), as both the level 1 and 2 variances are on the same scale [15]. All multi-level models were performed with MLwiN version 2.0 [18].…”

“…Practice characteristics collected through a baseline practice profile survey included the number of GPs at a practice, the number of full-time-equivalent (FTE) GPs, "the current self-reported quality of referral linkages between practice and AHPs was assessed at interview with the principal GP of each practice using the Clinical Linkages questionnaire [15]. This instrument asks GPs to rate the quality of the service provided and communication to assess the linkages with the external service providers (practices which scored >75% were rated as 'high', other- wise as 'low')"and the intervention group the practice was assigned to.…”