Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT)

Abstract

Objective: To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT.  Background: Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent upon the purpose and utility of the instrument used.  Methods: CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach’s alpha. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria was applied to judge aspects of utility.  Results: CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach’s alpha coefficient for internal consistency indicated high reliability (0.78). Inter-item (question) total correlations (0.28-0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact.  Conclusions: CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the five item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility are also required.  STRENGTHS AND LIMITATIONS OF THIS STUDY  The psychometric findings demonstrate the structural validity and internal consistency of CEFIT to quantify the patient experience of quality of healthcare.  While the large sample (n=802) enabled exploration of the CEFIT structure the findings are limited to an Australian community population, with a healthcare experience, as opposed to inpatients.  Validity and reliability are not all or nothing approaches. Rather, each study with positive results adds to the psychometric strength of the instrument. Further testing of CEFIT is required to establish the utility of CEFIT to measure patient experience of hospital quality of care for quality improvement at a ward/unit level.