The Development and Testing of an Instrument to Measure Quality of Home and Community Based Long-term Care Delivery
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The Development and Testing of an Instrument to Measure Quality of Home and Community Based Long-term Care Delivery

  • Author(s): Dobell, Louisa
  • Advisor(s): Newcomer, Robert
  • et al.
Abstract

Purpose This paper reports on the development and testing of the Consumer Satisfaction Measurement Instrument (ConSat), an instrument intended for use with frail elder care-recipients enrolled in the Program of All-Inclusive Care for the Elderly (PACE), an integrated home and community-based long-term care model with 52 care delivery centers located throughout the United States.

Design and Methods Observations of care delivery, a review of existing satisfaction instruments, and six care-recipient and one provider focus group were conducted to create a conceptual framework relevant to the PACE care-recipient population. Forty cognitive interviews were used to pre-test a first draft of the ConSat instrument (ConSat Draft 1). A revised instrument (ConSat Draft 2) was then field tested with care-recipients with no limitation in cognitive ability using an in-person interview methodology. Data from 324 interviews were used to analyze the psychometric properties of the ConSat instrument.

Results Three core domains of satisfaction: interpersonal processes of care, staff performance, and system adequacy measured across eight services capture the experience of care for frail elders receiving home and community-based long-term care. Factor analysis confirmed the structure of the model and estimates of internal consistency reliability for six of eight instrument scales exceeded a 0.70 criterion.

Implications This project contributes to the long-term care literature by addressing several issues that challenge satisfaction measurement with frail elders. The instrument is based on a definition of satisfaction that was created with the assistance of care-recipients. It measures satisfaction across a comprehensive range of services using dimensions and specific items drawn from observations of care and focus groups. It was pre-tested, revised, and field-tested to determine the psychometric properties of the instrument. Support for the reliability and validity of the ConSat instrument in the PACE population suggests that it may be an effective means of measuring the quality of integrated long-term care from the care-recipient perspective. However, further testing should be conducted to determine how cultural and sociodemographic factors influence reports of satisfaction using the ConSat instrument.

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