Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care

Stefan G. Kertesz; David E. Pollio; Richard N. Jones; Jocelyn Steward; Erin J. Stringfellow; Adam J. Gordon; Nancy K. Johnson; Theresa A. Kim; Shanette G. Daigle; Erika L. Austin; Alexander S. Young; Joya G. Chrystal; Lori L. Davis; David L. Roth; Cheryl L. Holt

doi:10.1097/MLR.0000000000000160

Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care

Stefan G. Kertesz, David E. Pollio, Richard N. Jones, Jocelyn Steward, Erin J. Stringfellow, Adam J. Gordon, Nancy K. Johnson, Theresa A. Kim, Shanette G. Daigle, Erika L. Austin, Alexander S. Young, Joya G. Chrystal, Lori L. Davis, David L. Roth, Cheryl L. Holt

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

BACKGROUND:: Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns. OBJECTIVES:: This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients; and (b) the methods utilized in its development. METHODS:: Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function (TIF) curves to eliminate less informative items and devise plausibly distinct subscales. RESULTS:: The resulting 33-item instrument (Primary Care Quality-Homeless) has 4 subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items), and Homeless-specific Needs (4 items). Evidence for divergent and convergent validity is provided. TIF graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation, and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (α=0.75) and patients frequently reported problems in this aspect of care. CONCLUSIONS:: Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development.

Original language	English (US)
Pages (from-to)	734-742
Number of pages	9
Journal	Medical care
Volume	52
Issue number	8
DOIs	https://doi.org/10.1097/MLR.0000000000000160
State	Published - Aug 2014
Externally published	Yes

Keywords

homeless health care
homeless persons
item response theory
patient satisfaction
patient-centered outcomes research
patientcentered care
survey methodology

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1097/MLR.0000000000000160

Cite this

Kertesz, S. G., Pollio, D. E., Jones, R. N., Steward, J., Stringfellow, E. J., Gordon, A. J., Johnson, N. K., Kim, T. A., Daigle, S. G., Austin, E. L., Young, A. S., Chrystal, J. G., Davis, L. L., Roth, D. L., & Holt, C. L. (2014). Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care. Medical care, 52(8), 734-742. https://doi.org/10.1097/MLR.0000000000000160

Kertesz, SG, Pollio, DE, Jones, RN, Steward, J, Stringfellow, EJ, Gordon, AJ, Johnson, NK, Kim, TA, Daigle, SG, Austin, EL, Young, AS, Chrystal, JG, Davis, LL, Roth, DL & Holt, CL 2014, 'Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care', Medical care, vol. 52, no. 8, pp. 734-742. https://doi.org/10.1097/MLR.0000000000000160

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title = "Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care",

abstract = "BACKGROUND:: Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns. OBJECTIVES:: This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients; and (b) the methods utilized in its development. METHODS:: Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function (TIF) curves to eliminate less informative items and devise plausibly distinct subscales. RESULTS:: The resulting 33-item instrument (Primary Care Quality-Homeless) has 4 subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items), and Homeless-specific Needs (4 items). Evidence for divergent and convergent validity is provided. TIF graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation, and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (α=0.75) and patients frequently reported problems in this aspect of care. CONCLUSIONS:: Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development.",

keywords = "homeless health care, homeless persons, item response theory, patient satisfaction, patient-centered outcomes research, patientcentered care, survey methodology",

author = "Kertesz, {Stefan G.} and Pollio, {David E.} and Jones, {Richard N.} and Jocelyn Steward and Stringfellow, {Erin J.} and Gordon, {Adam J.} and Johnson, {Nancy K.} and Kim, {Theresa A.} and Daigle, {Shanette G.} and Austin, {Erika L.} and Young, {Alexander S.} and Chrystal, {Joya G.} and Davis, {Lori L.} and Roth, {David L.} and Holt, {Cheryl L.}",

year = "2014",

month = aug,

doi = "10.1097/MLR.0000000000000160",

language = "English (US)",

volume = "52",

pages = "734--742",

journal = "Medical Care",

issn = "0025-7079",

publisher = "Lippincott Williams and Wilkins",

number = "8",

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TY - JOUR

T1 - Development of the primary care quality-homeless (PCQ-H) instrument

T2 - A practical survey of homeless patients' experiences in primary care

AU - Kertesz, Stefan G.

AU - Pollio, David E.

AU - Jones, Richard N.

AU - Steward, Jocelyn

AU - Stringfellow, Erin J.

AU - Gordon, Adam J.

AU - Johnson, Nancy K.

AU - Kim, Theresa A.

AU - Daigle, Shanette G.

AU - Austin, Erika L.

AU - Young, Alexander S.

AU - Chrystal, Joya G.

AU - Davis, Lori L.

AU - Roth, David L.

AU - Holt, Cheryl L.

PY - 2014/8

Y1 - 2014/8

N2 - BACKGROUND:: Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns. OBJECTIVES:: This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients; and (b) the methods utilized in its development. METHODS:: Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function (TIF) curves to eliminate less informative items and devise plausibly distinct subscales. RESULTS:: The resulting 33-item instrument (Primary Care Quality-Homeless) has 4 subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items), and Homeless-specific Needs (4 items). Evidence for divergent and convergent validity is provided. TIF graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation, and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (α=0.75) and patients frequently reported problems in this aspect of care. CONCLUSIONS:: Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development.

AB - BACKGROUND:: Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns. OBJECTIVES:: This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients; and (b) the methods utilized in its development. METHODS:: Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function (TIF) curves to eliminate less informative items and devise plausibly distinct subscales. RESULTS:: The resulting 33-item instrument (Primary Care Quality-Homeless) has 4 subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items), and Homeless-specific Needs (4 items). Evidence for divergent and convergent validity is provided. TIF graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation, and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (α=0.75) and patients frequently reported problems in this aspect of care. CONCLUSIONS:: Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development.

KW - homeless health care

KW - homeless persons

KW - item response theory

KW - patient satisfaction

KW - patient-centered outcomes research

KW - patientcentered care

KW - survey methodology

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Development of the primary care quality-homeless (PCQ-H) instrument: A practical survey of homeless patients' experiences in primary care

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