Validation of the care transition measure in multi-ethnic South-East Asia in Singapore

Abstract

BackgroundThe 15-item Care Transition Measure (CTM-15) is a measure for assessing the quality of care during transition from the patients’ perspective. The purpose of this study was to test the psychometric properties of the CTM-15 and CTM-3 (a 3-item version of the CTM-15) in Singapore, a multi-ethnic urban state in South-east Asia.MethodsA consecutive sample of patients was recruited from two tertiary hospitals. The subjects or their proxies were interviewed 3 weeks after discharge from hospital to home in English or Chinese using the CTM-15 questionnaire. Information about patients’ visit to emergency department (ED), non-elective rehospitalisation for the condition of index hospitalisation, and care experience after discharge was also collected from respondents. Psychometric properties of CTM-15 and CTM-3 based on the five-point response scale (i.e. strongly disagree, disagree, neutral, agree, and strongly agree) and the three-point response scale (i.e. [strongly] agree, neutral, and [strongly] disagree) were tested for English and Chinese versions separately. Internal consistency reliability was assessed using Cronbach’s alpha and construct validity was tested with T-test or Pearson’s correlation by examining hypothesised association of CTM scores with ED visit, rehospitalisation, and experience with care after discharge. Exploratory factor analysis was performed to examine latent dimensions of CTM-15.ResultsA total of 414 (proxy: 96.1%) and 165 (proxy: 84.8%) subjects completed the interviews in English and Chinese, respectively. Cronbach’s alpha values of the different CTM-15 versions ranged from 0.81 to 0.87. In contrast, Cronbach’s alpha values of the CTM-3 ranged from 0.42 to 0.63. Both CTM-15 and CTM-3 were correlated with care experience after discharge regardless of survey language or response scale (Pearson’s correlation coefficient: 0.36 to 0.46). Among the English-speaking respondents, the CTM-15 and CTM-3 scores based on both the three- and five-point response scales discriminated well between patients with and without ED visits or rehospitalisation for their index condition. Among Chinese-speaking respondents, no difference in CTM scores was observed between patients with and without ED visits or patients with and without rehospitalisation. The English and Chinese versions of the CTM-15 items demonstrated a similar 4-factor structure representing general care plan, medication, agreement on care plan, and specific care instructions.ConclusionsThe care transition measure is a valid and reliable measure for quality of care transition in Singapore. Moreover, the care transition measure can be administered to proxies using a simpler response scale. The discriminatory power of the Chinese version of this instrument needs to be further tested in future studies.

Validity and reliability of the Japanese version of the Care Transitions Measure

“…The J‐CTM‐15 was found to comprise 3 factors, demonstrating a different structure when compared to the original factor model, which is similar to the finding of previous studies conducted in Singapore and Israel . Factor 2 was composed of items such as “Self‐management support” and “Patient and caregiver preparation.” In the Japanese version, Factor 2 labeled “Understanding and confidence of self‐management” was different from the factor “Critical understanding” and “Management preparation,” which were proposed in the original CTM‐15.…”

Patients’ views on the quality of transitional care at a health insurance hospital in Alexandria, Egypt

“…The results revealed that the transitional care received by the study population was suboptimal compared with studies in USA and Singapore using the same measure and another study in Canada using a different measure (the total CTM score in the present study was 42.2 compared with a total score of 66.0 in Singapore, 67.34 in USA, and a mean score percentage of 80.8 in Canada) [12,14,15]. The present study aimed to assess the quality of transitional care at one HIO hospital in Egypt from the patients' perspective using the CTM.…”

“…As for the dimension concerning patients' agreement on care plans, the total score was 33.5 compared with scores of 66.6 and 67.2 in two studies conducted in Singapore and USA, respectively [12,14]. This could be explained by the desire of healthcare providers to maintain control, lack of time and lack of training in skills of providing a patientcentered care in the current study setting.…”

Validación del cuestionario CTM-3-modificado sobre satisfacción con la continuidad de cuidados: un estudio de cohortes

“…La Care Transmision Measure ha sido validada y utilizada con éxito en entornos lingüísticos y culturales diferentes al anglosajón (5,12,14,15), si bien no se han encontrado estudios que se hayan centrado en las características psicométricas de la encuesta en español.…”