Validity and Reliability of the Thai Version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) Survey for Maintenance Hemodialysis Patients

Validity and Reliability of the Thai Version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) Survey for Maintenance Hemodialysis Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validity and Reliability of the Thai Version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) Survey for Maintenance Hemodialysis Patients Jirawat Phuphanitcharoenkun, Phoom Narongkiatikhun, Vuddhidej Ophascharoensuk This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4300017/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 21 You are reading this latest preprint version Abstract Background Patient-reported experience measures (PREMs) are important tools for evaluating the quality of care from patients' perspectives. Nevertheless, no validated PREMs exist for maintenance hemodialysis (MHD) patients in Thailand. This study aimed to develop a Thai version of the Consumer Assessment of Healthcare Providers and System In-center Hemodialysis (CAHPS-ICH) survey and assess its validity and reliability. Method We translated the original CAHPS-ICH ® survey into Thai and administered it to MHD patients at the hemodialysis center of Chiang Mai University Hospital. Correlation analysis was employed to evaluate the construct validity of each domain (Nephrologists’ communication and caring [NCC], quality of dialysis center cares and operation [QoC] and providing information to patients [PI]) and the global rating scales. Internal consistency and test-retest reliability were assessed using Cronbach's alpha coefficient (α) and intraclass correlation coefficient (ICC), respectively. Results A total of 189 patients were recruited. The NCC domain exhibited the strongest correlation with the doctor global rating scale (r = 0.60) and displayed good internal consistency (α = 0.86). The QoC domain indicated positive correlations with the staff and center rating scales (r = 0.65 and 0.58, respectively) and demonstrated acceptable internal consistency (α = 0.78). The PI domain showed a moderate association with the center global rating scales (r = 0.31), but its internal consistency was not demonstrated (α = 0.53). Most multi-item scale questions showed satisfactory test-retest reliability (ICC = 0.50–0.85). Conclusion The “Thai CAHPS-ICH” survey proves to be a valid and reliable tool for assessing the patient experience among MHD patients at Chiang Mai University Hospital. Patient-reported experience measure maintenance hemodialysis Thai CAHPS-ICH survey Figures Figure 1 Introduction In Thailand, there has been a growing demand for renal replacement therapy (RRT) among patients with end-stage kidney disease (ESKD). In 2016, the incidence of ESKD in Thailand was 346 patients per million people per year, compared to 100 per million people per year in 2008.( 1 ) Consequently, it is imperative to assess patient outcomes post-dialysis to enhance the quality of care. Various aspects of the "quality pyramid" have been discussed in terms of quality in ESKD programs, including the higher hierarchies of care such as mortality, hospitalization, patient experience and health-related quality of life (HRQoL).( 2 ) To evaluate the quality of care from patients' perspectives and their HRQoL, patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) have been established. These measures aim to improve the quality of care and clinical effectiveness. Several PROMs and PREMs have been developed and validated for adults with kidney diseases, including the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey and the Consumer Quality Index of Chronic Dialysis, which have validated renal-specific PREMs.( 3 – 5 ) The CAHPS-ICH survey comprises 58 items that assess three domains: nephrologist communications and caring (NCC; 6 items), dialysis center care and operation (QoC; 17 items) and providing information to patients (PI; 9 items), along with 3 global rating scales that measure nephrologists, dialysis center staff, and dialysis center.( 5 ) The CAHPS-ICH survey is the first patient-reported quality metric added to the End-Stage Renal Disease Quality Program (ESRD QIP). The US Centers of Medicare & Medicaid Services (CMS) initiated national implementation of this survey in 2014.( 6 ) Additionally, this survey has been translated into numerous languages, includung Spanish, Chinese, and Samoan.( 7 ) Many studies have shown an association between survey scores and patient and dialysis facility characteristics.( 5 , 8 – 10 ) However, to date, the relevance of the survey to clinical outcomes has not been demonstrated.( 11 ) In Thailand, no validated PREMs for MHD patients are available. Therefore, this study aimed to develop a PREM for Thai patients, specifically among MHD patients, and to evaluate its validity and reliability. Methods Translational process The translational process commenced following permission approval, guided by the guideline for translation and cultural adaptation.( 12 ) The permission request was submitted via email to David I. Lewin, the Health Communications Specialist/Manager of Copyrights & Permissions, Agency of Healthcare Research and Quality, who is responsible for the international requests for the CAHPS survey usage. Second, two independent forward translations of the English version of the CAHPS-ICH to Thai were conducted, one by a medical personal and the other by an individual without a medical background. To reconcile any discrepancies between these two translations, they were discussed and resolved by an expert committee. Third, a backward translation into English was performed by a language expert, who was blinded to the original English version. Fourth, all the translations and discrepancies were reviewed by the expert committee, comprising nephrologists, hemodialysis nurses, and language professionals, until a consensus was reached for all the items. Moreover, the committee compared the back-translated version with the original to identify any inconsistent conception and create the preliminary version of the Thai CAHPS-ICH. Following this, the committee made necessary corrections and adjustments, resulting in the final version of the "Thai CAHPS-ICH" questionnaire. Study Designs and Population We conducted a prospective observational study at the dialysis center of Chiang Mai University Hospital. This study enrolled participants who were 18 years of age or older, of Thai nationality, and who had received maintenance hemodialysis for at least 3 months at Chiang Mai University Hospital. The exclusion criteria were patients who were unable to communicate, who had cognitive impairment, who required assistance (defined as patients with a Karnofsky Performance Status Scale score below 50), who received temporary hemodialysis, or who received regular hemodialysis from another hemodialysis center. Data collection The trial was approved by the Ethics Committee of Chiang Mai University (MED-2565-09133). Eligible patients were identified by research assistants and hemodialysis nurses. Upon completion of the informed consent process, all participants filled out the "Thai CAHPS-ICH" survey. For independent individuals, questionnaires had to be self-completed and returned during the next dialysis session. Minor assistance, defined as aid from caregivers or next-of-kin in reading questions and recording answers for patients unable to read or write, was acceptable. Questionnaires completed by someone else or with a response rate below 50% were excluded. The questionnaire underwent retesting four weeks later using the same methods. Patient demographic data were collected, and hemodialysis and laboratory parameters were recorded. The weekly dosage of all erythropoietin stimulating agents (ESAs) was converted to erythropoietin alfa dosage using a conversion table(13). Trained nurses collected all data via case record forms. Statistical analysis and sample size We determined the survey response rate and used means, medians, standard deviations, frequency tables, and rates to describe the patient characteristics. Ceiling and floor effects were utilized to assess all Likert scales in the survey, considering effects significant if items scored by responders exceeded 15% for each item. To evaluate construct validity, we compared the three domains in the "Thai CAHPS-ICH" survey (NCC, QoC, PI) with global rating scales for nephrologists, hemodialysis staff, and the hemodialysis center. Pearson and Spearman correlation analyses were used for continuous and categorical variables, respectively. Correlation coefficients between 0.1–0.29, 0.3–0.49, and 0.5 or above are considered small, medium, and large associations, respectively.( 14 ) Reliability of the questionnaires was evaluated through internal consistency reliability and test-retest reliability. Internal consistency of each domain was measured using Cronbach’s alpha coefficient, with values ≥ 0.7–0.8, > 0.8–0.9, and > 0.9 considered acceptable, good, and excellent for aggregate data, respectively. The intraclass correlation coefficient (ICC) was used to evaluate test-retest reliability, with values < 0.5, 0.5-<0.75, 0.75-<0.9, and 0.9-1 indicating poor, fair, good, and excellent agreement, respectively.( 15 ) This repeatability was evaluated using questionnaires at the start and fourth week after enrollment. Statistical software used in this study was SPSS, version 17.0 (SPSS Inc., Chicago, IL, USA). According to the sample size estimation for reliability studies, the minimum required sample size was 118 to achieve alpha errors of 0.05 and a power of 0.20.( 16 ) The anticipated response rate was approximately 40%, based on findings from a previous study.( 17 ) In our dialysis center, the total number of MHD patients was at least 300. Therefore, we aimed to recruit all patients to complete the questionnaire. Results During September and December 2022, there were 295 MHD patients at the dialysis center of Chiang Mai University Hospital. As depicted in Fig. 1 , 106 patients were excluded. One hundred eighty-nine patients were included in the analysis. The survey response rate was 80.43%. Patient characteristics are shown in Table 1 . The mean age was 58.28 ± 14.87 years. The majority of patients were aged between 55 and 74 years (55.56%). The median dialysis vintage was 39 months (IQR; 18,72). Among the 189 patients included in the analysis, 143 (75.66%) completed the questionnaire themselves. Our “Thai CAHPS-ICH” survey is provided in the supplementary appendix. Table 1 Patient characteristics at baseline Characteristics N (%) (Total=189) Age (years old) 18 – 34 35 – 54 55 – 74 75 or more 12 (6.35) 53 (28.04) 105 (55.56) 19 (10.05) Sex Male Female 107 (56.61) 82 (43.39) BMI (kg/m 2 ) 25 23 (12.17) 72 (38.10) 37 (19.58) 57 (30.16) Hemodialysis Vintage 3 months – less than 1 year 1 – less than 5 years 5 years or more 31 (16.40) 100 (52.91) 58 (30.69) Education Elementary School Junior high school Senior high school Bachelor Master’s degree or more 56/187 (29.95) 17/187 (9.09) 30/187 (16.04) 63/187 (33.69) 21/187 (11.23) Survey response Self-complete Reading the question Writing down the given answer Translating the question into local language 143 (75.66) 43 (22.75) 25 (13.23) 4 (2.12) The ceiling and floor effects are shown in Table 2 . All the 10-point global rating scales (Q8, Q32, and Q35) exhibited significant ceiling effects (ranging from 39.89 to 48.91%). Ceiling effects were also observed in most composites of the NCC and QoC domains, with exceptions noted for “Q24 staff manage problem” (12.07%) and “Q43 satisfied with way problems handled” (1.14%). None of the questions demonstrated significant floor effects (0–13.89%). Table 2 Ceiling and floor of the Thai CAHPS-ICH Thai CAHPS-ICH Baseline 1 month %Ceiling effect %Floor effect %Ceiling effect %Floor effect Q3 Doctor listens carefully 59.57 1.06 52.69 0.60 Q4 Doctor explains things 38.67 2.76 42.17 1.81 Q5 Doctor shows respect 47.49 0 44.85 0.61 Q6 Doctor spends enough time 42.54 0.55 48.19 0 Q7 Doctor cared about you 48.62 1.10 46.99 0.60 Q8 Nephrologists’ communication and caring 39.89 0 43.71 0 Q10 Staff listen carefully 64.84 0 59.52 0 Q11 Staff explain in a way that is easy to understand 55.25 0 54.76 0 Q12 Staff show respect 51.65 0 55.36 0 Q13 Staff spend enough time 57.07 0 52.69 0.60 Q14 Staff cared about you 57.84 0 55.95 0 Q15 Staff makes you comfortable 61.41 0.54 62.50 2.38 Q21 Staff insert needle without pain 34.07 1.65 36.42 0 Q22 Staff check you closely 57.61 0.54 52.07 1.18 Q24 Staff manage problems 12.07 0 17.18 0.61 Q25 Staff professional 64.77 0 56.36 1.82 Q27 Staff explain tests 32.42 4.95 31.52 4.24 Q32 Quality of Dialysis Center Care and Operations 46.70 0 46.43 0 Q33 On machine within 15 min 32.78 13.89 35.33 10.78 Q34 Center clean 67.21 0.55 65.87 0 Q35 Providing Information to Patients 48.91 0 50.90 0 Q43 Satisfied with way problems handled 1.14 0 1.23 1.23 Table 3 displays the results of the validity assessment, presenting the correlations between survey domains and global rating scales. The NCC domain demonstrated a strong association with the global rating scale of nephrologists (r = 0.60). Similarly, the QoC scale exhibited a strong association with the global rating scales of staff and center (r = 0.65 and r = 0.58, respectively). Additionally, a moderate association was observed between the PI scale and center global rating scale (r = 0.31). Table 3 Correlations between Scales and Global Rating Scales Scale domains Doctor rating scale Staff rating scale Center rating scale Nephrologists’ Communication and Caring (NCC) 0.60 0.45 0.38 Quality of Dialysis Center Care and Operations (QoC) 0.37 0.65 0.58 Providing Information to Patients (PI) 0.17 0.26 0.31 All correlations are significant at P < 0.05 The correlations between each multi-item scale and all three global rating scales are outlined in Table 4 . Five out of six items from the NCC domain demonstrated a strong correlation with the doctor global rating scale (r = 0.51–0.58). Additionally, ten out of 17 items in the QoC domain were associated with the staff and center rating scales (r = 0.45–0.59 and r = 0.34–0.55, respectively). However, no correlation was detected between the PI domain and any of the global rating scales. Table 4 Item-scale correlations of the Thai CAHPS-ICH composites Items Scales Doctor rating Staff rating Center rating Q3 Doctor listens carefully (n = 176) Q4 Doctor explains things (n = 175) Q5 Doctor shows respect (n = 173) Q6 Doctor spends enough time (n = 175) Q7 Doctor cared about you (n = 175) Q9 Doctor seemed informed (n = 163) 0.51 a 0.58 a 0.55 a 0.54 a 0.55 a -0.03 0.42 a 0.42 a 0.44 a 0.37 a 0.48 a -0.07 0.38 a 0.43 a 0.41 a 0.42 a 0.55 a <-0.001 Q10 Staff listen carefully (n = 174) Q11 Staff explain in a way that is easy to understand (n = 174) Q12 Staff show respect (n = 172) Q13 Staff spend enough time (n = 173) Q14 Staff cared about you (n = 174) Q15 Staff makes you comfortable (n = 173) Q16 Staff keep information private (n = 168) Q17 Comfortable asking staff (n = 173) Q21 Staff insert needle without pain (n = 171) Q22 Staff check you closely (n = 173) Q24 Staff manage problems (n = 168) Q25 Staff professional (n = 170) Q26 Staff discuss diet (n = 174) Q27 Staff explain tests (n = 176) Q33 On machine within 15 min (n = 174) Q34 Center clean (n = 175) Q43 Satisfied with way problems handled (n = 167) 0.28 a 0.33 a 0.39 a 0.38 a 0.34 a 0.37 a 0.02 -0.08 0.07 0.33 a -0.04 0.33 a -0.24 a 0.34 a 0.22 a 0.33 a -0.15 a 0.48 a 0.50 a 0.59 a 0.51 a 0.57 a 0.54 a -0.08 -0.03 0.16 a 0.54 a -0.04 0.47 a -0.25 a 0.49 a 0.25 a 0.46 a -0.27 a 0.37 a 0.44 a 0.48 a 0.39 a 0.42 a 0.46 a -0.04 0.02 0.15 0.47 a -0.06 0.34 a -0.14 0.37 a 0.25 a 0.55 a -0.22 a Q19 Know how to care of access site (n = 173) Q28 Staff give information on patient rights (n = 169) Q29 Staff review patient rights (n = 167) Q30 Staff told you what to do if health problem at home (n = 176) Q31 Staff told you how to get off machine if emergency (n = 173) Q36 Doctor/staff talk about which treatment is right for you (n = 165) Q38 Doctor/staff explain why not eligible for transplant (n = 171) Q39 Doctor/staff talk about peritoneal dialysis (n = 168) Q40 Involved in choosing treatment (n = 168) -0.06 -0.25 a -0.30 a -0.13 -0.03 -0.10 -0.14 -0.20 a -0.08 -0.20 a -0.30 a -0.31 a -0.24 a -0.11 -0.04 -0.14 -0.20 a -0.07 -0.21 a -0.22 a -0.32 a -0.15 a -0.15 a -0.06 -0.13 -0.21 a -0.01 a p < 0.05 For internal consistency reliability, the composites of the Nephrologists’ Communication (6 items) and Quality of Dialysis Center Care and Operations (17 items) domains exhibited good and acceptable reliability (α = 0.86 and 0.78, respectively). However, the PI composite did not demonstrate internal consistency (α = 0.53). (Table 5) Table 5 Internal Consistency Reliability Domains Cronbach’s alpha (α) Nephrologists’ Communication and Caring (6 items) Quality of Dialysis Center Care and Operations (17 items) Providing Information to Patients (9 items) 0.86 0.78 0.53 Most of the multi-item scales exhibited test-retest repeatability (intraclass correlation coefficient; ICC, 0.55–0.85). However, one multi-item scale (Q43 Satisfied with way problems handled) did not demonstrate this reliability (ICC = 0.19). Test-retest reliability was observed for 4 out of the 13 yes/no questions, all of which are in the PI domain (Q29, Q30, Q31, and Q38) as shown in Table 6 . Table 6 Intraclass correlation Items ICC 95%CI P value Q3 Doctor listens carefully 0.66 0.54–0.75 < 0.001 Q4 Doctor explains things 0.68 0.67–0.77 < 0.001 Q5 Doctor shows respect 0.66 0.53–0.75 < 0.001 Q6 Doctor spends enough time 0.59 0.43–0.70 < 0.001 Q7 Doctor cared about you 0.56 0.40–0.68 < 0.001 Q8 Nephrologists’ communication and caring 2 0.64 0.51–0.73 < 0.001 Q9 Doctor seemed informed 1 0.48 0.28–0.62 < 0.001 Q10 Staff listen carefully 0.70 0.59–0.78 < 0.001 Q11 Staff explain in a way that is easy to understand 0.65 0.52–0.74 < 0.001 Q12 Staff show respect 0.70 0.60–0.78 < 0.001 Q13 Staff spend enough time 0.66 0.53–0.75 < 0.001 Q14 Staff cared about you 0.62 0.49–0.72 < 0.001 Q15 Staff makes you comfortable 0.63 0.49–0.72 < 0.001 Q16 Staff keep information private 1 0.22 -0.07–0.43 0.061 Q17 Comfortable asking staff 1 -0.06 -0.44–0.22 0.638 Q21 Staff insert needle without pain 0.85 0.79–0.89 < 0.001 Q22 Staff check you closely 0.57 0.42–0.68 < 0.001 Q24 Staff manage problems 0.50 0.31–0.63 < 0.001 Q25 Staff professional 0.61 0.47–0.72 < 0.001 Q26 Staff discuss diet 1 0.30 0.05–0.49 0.012 Q27 Staff explain tests 0.61 0.47–0.71 < 0.001 Q32 Quality of Dialysis Center Care and Operations 2 0.70 0.60–0.78 < 0.001 Q33 On machine within 15 min 0.65 0.52–0.74 < 0.001 Q34 Center clean 0.54 0.37–0.66 < 0.001 Q35 Providing Information to Patients 2 0.79 0.72–0.85 < 0.001 Q43 Satisfied with way problems handled 0.19 -0.12–0.41 0.105 Q19 Know how to care of access site 1 0.28 0.02–0.47 0.020 Q28 Staff give information on patient rights 1 0.13 -0.19–0.37 0.190 Q29 Staff review patient rights 1 0.68 0.55–0.77 < 0.001 Q30 Staff told you what to do if health problem at home 1 0.58 0.42–0.69 < 0.001 Q31 Staff told you how to get off machine if emergency 1 0.57 0.41–0.69 < 0.001 Q36 Doctor/staff talk about which treatment is right for you 1 0.34 0.09–0.52 0.006 Q38 Doctor/staff explain why not eligible for transplant 1 0.70 0.59–0.79 < 0.001 Q39 Doctor/staff talk about peritoneal dialysis 1 0.47 0.27–0.61 < 0.001 Q40 Involved in choosing treatment 1 0.44 0.23–0.59 < 0.001 1 Yes/No question 2 Global rating scale We compared the results of our “Thai CAHPS-ICH” survey and the original ICH-CAHPS® survey in Table 7 . The response rate in our study was higher than that of the original survey (80.43% vs. 46%). Both surveys demonstrated internal consistency in the NCC and QoC domains (⍺ = 0.86 and 0.78 in the Thai CAHPS-ICH survey, and ⍺ = 0.81 and 0.90 in the ICH-CAHPS ® survey, respectively). However, neither survey showed internal consistency in the PI domain (⍺ = 0.53 in the Thai CAHPS-ICH survey and ⍺ = 0.55 in the ICH-CAHPS ® survey). Regarding validity, both surveys exhibited correlations between the NCC domain and the doctor rating scale (r = 0.60 and 0.78 in the Thai CAHPS-ICH and original ICH-CAHPS® surveys, respectively), between the QoC domain and the staff rating scale (r = 0.65 and 0.75 in the Thai CAHPS-ICH and original ICH-CAHPS ® surveys, respectively), and between the QoC and the center rating scale (r = 0.58 and 0.69 in the Thai CAHPS-ICH and original ICH-CAHPS® surveys, respectively). However, both surveys showed less strong correlations between the PI domain and all global rating scales. Table 7 Comparison between the Thai CAHPS-ICH and original ICH-CAHPS ® ( 5 , 17 ) Contents Thai CAHPS-ICH Original ICH-CAHPS ® Study design (n) Single center study in Chiang Mai (n = 189) Multicenter study in US (n = 819) Data collection Questionnaire form Telephone or mailed survey Response rate 80.43% 46% Reliability ⍺ 1 = 0.86 (NCC), 0.78 (QoC), 0.53 (PI) ⍺ 1 = 0.81 (NCC), 0.90 (QoC), 0.55 (PI) Validity(r) 2 - 0.60 between NCC and Doctor GRS - 0.65 between QoC and Staff GRS - 0.58 between QoC and Center GRS - < 0.5 between PI domain and all GRS - 0.78 between NCC and Doctor GRS - 0.75 between QoC and Staff GRS - 0.69 between QoC and Center GRS - < 0.5 between PI domain and all GRS 1 Cronbachs’ alpha coefficient 2 Correlation coefficient (r) of value ≥ 0.3 and ≥ 0.4 were considered association for Thai CAHPS-ICH and for Original ICH-CAHPS respectively. Discussion This was the first study to develop and evaluate our “Thai CAHPS-ICH” survey for MHD patients in Thailand. Given the scarcity of evidence on patient experience and care quality within this context, we aimed to investigate the correlation between care quality and patient outcomes. As the first phase of our project, we intended to verify that the survey could project the details of the quality of care. Our findings indicate that the "Thai CAHPS-ICH" survey demonstrates construct validity and achieves acceptable to good internal consistency reliability. The ceiling effects were significant across all three global rating scales and the majority of multi-item scales, except for Q24 and Q43. Conversely, the floor effects were minimal. These ceiling effects were consistent with those observed in the original ICH-CAHPS® survey, ranging from 15% in the QoC composite to 75% in the kidney doctor global rating.( 5 ) These findings may be attributed to the good quality of care provided by our academic hemodialysis facility. In assessing the construct validity of this survey, we observed large associations between the NCC domain and the kidney doctor rating scale, the QoC domain and staff rating scale, as well as the QoC domain and center rating scale. These findings indicate that the expected measure within each domain correlated with the intended aspects of assessment. The strongest correlations within each domain were similar to those found in the original survey.( 17 ) However, the PI domain, aimed at evaluating patients’ understanding of the information provided by nephrologists or dialysis staff, did not exhibit a significant correlation with any global rating scale. This negative result might be because none of the three global rating scales were specifically designed to assess this aspect. In evaluating the internal consistency and test-retest reliabilities of the Thai CAHPS-ICH survey, we found that the NCC and QoC domains exhibited good and acceptable internal consistency reliability, respectively. These results correspond with those of the original ICH-CAHPS ® survey.( 5 , 17 ) However, similar to the original ICH-CAHPS ® survey, the PI domain did not demonstrate internal consistency.( 5 ) Potential reasons for this outcome could include the heterogeneous nature of the questions within this domain and variations in patients' levels of literacy. Our study had several strengths. First, our survey represented the first Patient-Reported Outcome Measure for maintenance hemodialysis patients in Thailand, and we expected that this survey could be used to assess the quality of care among hemodialysis centers in Thailand. Second, we recruited all patients from a single dialysis center, which confirmed that the results apparently reflected the quality of care provided by the individual hemodialysis facility. However, our study also had some limitations. First, because of the absence of validated PREMs for Thai MHD patients, the comparison of each domain with its own components was not directly validated. Therefore, our survey had to validate each domain with 3 global rating scales. Second, this was a single-center study that could not be generalized to other hemodialysis centers in Thailand. Therefore, further studies evaluating the generalizability of this survey and the relationship between the survey score and clinical outcomes (e.g., laboratory parameters, health-related quality of life, hospitalization, mortality) are warranted. Conclusion The Thai version of the Consumer Assessment of Health Care Providers and Systems In-Center Hemodialysis, or "Thai CAHPS-ICH" survey, demonstrates reliability and validity among patients undergoing maintenance hemodialysis at Maharaj Nakorn Chiang Mai Hospital. This survey holds potential for application in other hemodialysis facilities across Thailand. Declarations Acknowledgment The authors thank David I. Lewin, the Health Communications Specialist/Manager of Copyrights & Permissions, Agency of Healthcare Research and Quality, who is responsible for the international requests for the CAHPS survey usage. Funding This study received support from a grant provided by the Faculty of Medicine, Chiang Mai University. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Availability of Data and Materials The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committee of Chiang Mai University (approbation number: MED-2565-09133) Informed consent Was waived by the Ethics Committee of Chiang Mai University (approbation number: MED-2565-09133) as it was a prospective observational study with data from the survey and medical electronic records. Consent for publication Not applicable. Competing interests All authors declare that they have no conflicts of interest. References Kanjanabuch T, Takkavabtakarn K. Global Dialysis Perspective: Thailand. Kidney360. 2020;1(7):671-5. Nissenson AR. Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm. Clinical Journal of the American Society of Nephrology. 2014;9(2):430-4. Nair D, Wilson FP. Patient-Reported Outcome Measures for Adults With Kidney Disease: Current Measures, Ongoing Initiatives, and Future Opportunities for Incorporation Into Patient-Centered Kidney Care. American Journal of Kidney Diseases. 2019;74(6):791-802. Aiyegbusi OL, Kyte D, Cockwell P, Anderson N, Calvert M. A patient-centred approach to measuring quality in kidney care: patient-reported outcome measures and patient-reported experience measures. Curr Opin Nephrol Hypertens. 2017;26(6):442-9. Wood R, Paoli CJ, Hays RD, Taylor-Stokes G, Piercy J, Gitlin M. Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey. Clin J Am Soc Nephrol. 2014;9(6):1099-108. In-Center Hemodialysis CAHPS Survey. National Implementation [Available from: https://ichcahps.org/General-Information/National-Implementation. In-Center Hemodialysis CAHPS Survey. Survey and Protocols [cited 2023 27th March]. Available from: https://ichcahps.org/Survey-and-Protocols. Dad T, Tighiouart H, Lacson E, Meyer KB, Weiner DE, Richardson MM. Hemodialysis patient characteristics associated with better experience as measured by the In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. BMC Nephrology. 2018;19(1):340. Psychometric Evaluation of the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey. American Journal of Kidney Diseases. 2019;73(5):667. Contextualizing the Interpretation of ICH-CAHPS Scores as a Measure of the Experience of Care of Dialysis Patients. American Journal of Kidney Diseases. 2019;73(5):739-40. Dad T, Grobert ME, Richardson MM. Using Patient Experience Survey Data to Improve In-Center Hemodialysis Care: A Practical Review. American Journal of Kidney Diseases. 2020;76(3):407-16. Beaton D, Bombardier C, Guillemin F, Ferraz M. Recommendations for the Cross-Cultural Adaptation of the DASH & QuickDASH Outcome Measures Contributors to this Document. Institute for Work & Health. 2007;1. Vega A, Abad S, Verdalles Ú, Aragoncillo I, Velázquez K, Quiroga B, et al. Dose equivalence between continuous erythropoietin receptor activator (CERA), Darbepoetin and Epoetin in patients with advanced chronic kidney disease. Hippokratia. 2014;18 4:315-8. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2 ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. p. 77-81. Perinetti G. StaTips Part IV: Selection, interpretation and reporting of the intraclass correlation coefficient. South European Journal of Orthodontics and Dentofacial Research. 2018;5. Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101-10. Weidmer BA, Cleary PD, Keller S, Evensen C, Hurtado MP, Kosiak B, et al. Development and evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey for in-center hemodialysis patients. Am J Kidney Dis. 2014;64(5):753-60. Additional Declarations Competing interest reported. All authors declare that they have no conflicts of interest. Supplementary Files SupplementaryAppendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 May, 2025 Reviews received at journal 20 May, 2025 Reviews received at journal 18 May, 2025 Reviews received at journal 18 May, 2025 Reviewers agreed at journal 14 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviews received at journal 13 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviewers agreed at journal 02 Apr, 2025 Reviewers agreed at journal 15 Nov, 2024 Reviewers agreed at journal 25 Sep, 2024 Reviewers agreed at journal 05 Aug, 2024 Reviewers agreed at journal 02 Aug, 2024 Reviews received at journal 01 Aug, 2024 Reviewers agreed at journal 01 Aug, 2024 Reviewers invited by journal 06 Jul, 2024 Editor assigned by journal 05 Jul, 2024 Editor invited by journal 30 Apr, 2024 Submission checks completed at journal 30 Apr, 2024 First submitted to journal 21 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4300017","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298247472,"identity":"af090146-3431-4108-ad92-df77664d0b01","order_by":0,"name":"Jirawat Phuphanitcharoenkun","email":"","orcid":"","institution":"Maharaj Nakorn Chiang Mai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jirawat","middleName":"","lastName":"Phuphanitcharoenkun","suffix":""},{"id":298247474,"identity":"059ce259-7065-4abb-bdf2-fd112cc1d78c","order_by":1,"name":"Phoom Narongkiatikhun","email":"","orcid":"","institution":"Maharaj Nakorn Chiang Mai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Phoom","middleName":"","lastName":"Narongkiatikhun","suffix":""},{"id":298247476,"identity":"26b2c058-5c16-48f2-bd7f-2bfeed5c8c1e","order_by":2,"name":"Vuddhidej Ophascharoensuk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYHACA2kGA2YGxvYeMI+Hj3gtPWcYGA4AtbARp4WBmYFBIgeshYGgFoMbyRtvFxRYyzHPfHvw8cccOxk2BuaHj27g1ZJWbD3DIN2YcXZessHBbclAh7EZG+fg0SI5I8dMmsfgcGLj7BwziYPbmIFaeNikidFS3zjzDEhLPWEt/BIQLQmMM3hAWg4ToYXnWbE1j0G6YWNPjrHB2W3HediYCfiFjR0YYjx/rOUN288YPqjcVm3Pz9788DE+LXBg2ABjMROjHATkiVU4CkbBKBgFIw8AALVhQTjEpCYZAAAAAElFTkSuQmCC","orcid":"","institution":"Maharaj Nakorn Chiang Mai Hospital","correspondingAuthor":true,"prefix":"","firstName":"Vuddhidej","middleName":"","lastName":"Ophascharoensuk","suffix":""}],"badges":[],"createdAt":"2024-04-21 08:54:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4300017/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4300017/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56041069,"identity":"a4cc2856-747d-4c2e-8132-aa849251e4da","added_by":"auto","created_at":"2024-05-07 19:25:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73325,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study participants\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4300017/v1/096df7ee167c1f5a79c726dc.png"},{"id":56041689,"identity":"a01576d1-7560-4236-b769-655396b53263","added_by":"auto","created_at":"2024-05-07 19:33:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864448,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4300017/v1/2e94e661-9ff3-4783-a723-583c8c660a63.pdf"},{"id":56040763,"identity":"4d9fd489-a82f-4405-b4be-2020846f5ccb","added_by":"auto","created_at":"2024-05-07 19:17:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":57368,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryAppendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4300017/v1/4317b8fb201c8d8e02705407.docx"}],"financialInterests":"Competing interest reported. All authors declare that they have no conflicts of interest.","formattedTitle":"Validity and Reliability of the Thai Version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) Survey for Maintenance Hemodialysis Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Thailand, there has been a growing demand for renal replacement therapy (RRT) among patients with end-stage kidney disease (ESKD). In 2016, the incidence of ESKD in Thailand was 346 patients per million people per year, compared to 100 per million people per year in 2008.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Consequently, it is imperative to assess patient outcomes post-dialysis to enhance the quality of care. Various aspects of the \"quality pyramid\" have been discussed in terms of quality in ESKD programs, including the higher hierarchies of care such as mortality, hospitalization, patient experience and health-related quality of life (HRQoL).(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTo evaluate the quality of care from patients' perspectives and their HRQoL, patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) have been established. These measures aim to improve the quality of care and clinical effectiveness. Several PROMs and PREMs have been developed and validated for adults with kidney diseases, including the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey and the Consumer Quality Index of Chronic Dialysis, which have validated renal-specific PREMs.(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe CAHPS-ICH survey comprises 58 items that assess three domains: nephrologist communications and caring (NCC; 6 items), dialysis center care and operation (QoC; 17 items) and providing information to patients (PI; 9 items), along with 3 global rating scales that measure nephrologists, dialysis center staff, and dialysis center.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) The CAHPS-ICH survey is the first patient-reported quality metric added to the End-Stage Renal Disease Quality Program (ESRD QIP). The US Centers of Medicare \u0026amp; Medicaid Services (CMS) initiated national implementation of this survey in 2014.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Additionally, this survey has been translated into numerous languages, includung Spanish, Chinese, and Samoan.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Many studies have shown an association between survey scores and patient and dialysis facility characteristics.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) However, to date, the relevance of the survey to clinical outcomes has not been demonstrated.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn Thailand, no validated PREMs for MHD patients are available. Therefore, this study aimed to develop a PREM for Thai patients, specifically among MHD patients, and to evaluate its validity and reliability.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTranslational process\u003c/h2\u003e \u003cp\u003e The translational process commenced following permission approval, guided by the guideline for translation and cultural adaptation.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) The permission request was submitted via email to David I. Lewin, the Health Communications Specialist/Manager of Copyrights \u0026amp; Permissions, Agency of Healthcare Research and Quality, who is responsible for the international requests for the CAHPS survey usage. Second, two independent forward translations of the English version of the CAHPS-ICH to Thai were conducted, one by a medical personal and the other by an individual without a medical background. To reconcile any discrepancies between these two translations, they were discussed and resolved by an expert committee. Third, a backward translation into English was performed by a language expert, who was blinded to the original English version. Fourth, all the translations and discrepancies were reviewed by the expert committee, comprising nephrologists, hemodialysis nurses, and language professionals, until a consensus was reached for all the items. Moreover, the committee compared the back-translated version with the original to identify any inconsistent conception and create the preliminary version of the Thai CAHPS-ICH. Following this, the committee made necessary corrections and adjustments, resulting in the final version of the \"Thai CAHPS-ICH\" questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Designs and Population\u003c/h2\u003e \u003cp\u003eWe conducted a prospective observational study at the dialysis center of Chiang Mai University Hospital. This study enrolled participants who were 18 years of age or older, of Thai nationality, and who had received maintenance hemodialysis for at least 3 months at Chiang Mai University Hospital. The exclusion criteria were patients who were unable to communicate, who had cognitive impairment, who required assistance (defined as patients with a Karnofsky Performance Status Scale score below 50), who received temporary hemodialysis, or who received regular hemodialysis from another hemodialysis center.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e The trial was approved by the Ethics Committee of Chiang Mai University (MED-2565-09133). Eligible patients were identified by research assistants and hemodialysis nurses. Upon completion of the informed consent process, all participants filled out the \"Thai CAHPS-ICH\" survey. For independent individuals, questionnaires had to be self-completed and returned during the next dialysis session. Minor assistance, defined as aid from caregivers or next-of-kin in reading questions and recording answers for patients unable to read or write, was acceptable. Questionnaires completed by someone else or with a response rate below 50% were excluded. The questionnaire underwent retesting four weeks later using the same methods.\u003c/p\u003e \u003cp\u003ePatient demographic data were collected, and hemodialysis and laboratory parameters were recorded. The weekly dosage of all erythropoietin stimulating agents (ESAs) was converted to erythropoietin alfa dosage using a conversion table(13). Trained nurses collected all data via case record forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis and sample size\u003c/h2\u003e \u003cp\u003eWe determined the survey response rate and used means, medians, standard deviations, frequency tables, and rates to describe the patient characteristics. Ceiling and floor effects were utilized to assess all Likert scales in the survey, considering effects significant if items scored by responders exceeded 15% for each item. To evaluate construct validity, we compared the three domains in the \"Thai CAHPS-ICH\" survey (NCC, QoC, PI) with global rating scales for nephrologists, hemodialysis staff, and the hemodialysis center. Pearson and Spearman correlation analyses were used for continuous and categorical variables, respectively. Correlation coefficients between 0.1\u0026ndash;0.29, 0.3\u0026ndash;0.49, and 0.5 or above are considered small, medium, and large associations, respectively.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Reliability of the questionnaires was evaluated through internal consistency reliability and test-retest reliability. Internal consistency of each domain was measured using Cronbach\u0026rsquo;s alpha coefficient, with values\u0026thinsp;\u0026ge;\u0026thinsp;0.7\u0026ndash;0.8, \u0026gt;\u0026thinsp;0.8\u0026ndash;0.9, and \u0026gt;\u0026thinsp;0.9 considered acceptable, good, and excellent for aggregate data, respectively. The intraclass correlation coefficient (ICC) was used to evaluate test-retest reliability, with values\u0026thinsp;\u0026lt;\u0026thinsp;0.5, 0.5-\u0026lt;0.75, 0.75-\u0026lt;0.9, and 0.9-1 indicating poor, fair, good, and excellent agreement, respectively.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) This repeatability was evaluated using questionnaires at the start and fourth week after enrollment. Statistical software used in this study was SPSS, version 17.0 (SPSS Inc., Chicago, IL, USA).\u003c/p\u003e \u003cp\u003eAccording to the sample size estimation for reliability studies, the minimum required sample size was 118 to achieve alpha errors of 0.05 and a power of 0.20.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) The anticipated response rate was approximately 40%, based on findings from a previous study.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) In our dialysis center, the total number of MHD patients was at least 300. Therefore, we aimed to recruit all patients to complete the questionnaire.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring September and December 2022, there were 295 MHD patients at the dialysis center of Chiang Mai University Hospital. As depicted in Fig. \u003cspan\u003e1\u003c/span\u003e, 106 patients were excluded. One hundred eighty-nine patients were included in the analysis. The survey response rate was 80.43%. Patient characteristics are shown in Table \u003cspan\u003e1\u003c/span\u003e. The mean age was 58.28\u0026thinsp;\u0026plusmn;\u0026thinsp;14.87 years. The majority of patients were aged between 55 and 74 years (55.56%). The median dialysis vintage was 39 months (IQR; 18,72). Among the 189 patients included in the analysis, 143 (75.66%) completed the questionnaire themselves. Our \u0026ldquo;Thai CAHPS-ICH\u0026rdquo; survey is provided in the supplementary appendix.\u003c/p\u003e\n\u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Patient characteristics at baseline\u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%) (Total=189)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years old)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e18 \u0026ndash;\u0026nbsp;34\u003c/p\u003e\n \u003cp\u003e35 \u0026ndash;\u0026nbsp;54\u003c/p\u003e\n \u003cp\u003e55 \u0026ndash;\u0026nbsp;74\u003c/p\u003e\n \u003cp\u003e75 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e12 (6.35)\u003c/p\u003e\n \u003cp\u003e53 (28.04)\u003c/p\u003e\n \u003cp\u003e105 (55.56)\u003c/p\u003e\n \u003cp\u003e19 (10.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e107 (56.61)\u003c/p\u003e\n \u003cp\u003e82 (43.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003cp\u003e18.5 \u0026ndash;\u0026nbsp;22.9\u003c/p\u003e\n \u003cp\u003e23 \u0026ndash;\u0026nbsp;25\u003c/p\u003e\n \u003cp\u003e\u0026gt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e23\u0026nbsp;(12.17)\u003c/p\u003e\n \u003cp\u003e72 (38.10)\u003c/p\u003e\n \u003cp\u003e37 (19.58)\u003c/p\u003e\n \u003cp\u003e57 (30.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemodialysis Vintage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e3 months \u0026ndash;\u0026nbsp;less than 1 year\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash;\u0026nbsp;less than 5 years\u003c/p\u003e\n \u003cp\u003e5 years or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e31\u0026nbsp;(16.40)\u003c/p\u003e\n \u003cp\u003e100\u0026nbsp;(52.91)\u003c/p\u003e\n \u003cp\u003e58\u0026nbsp;(30.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003cp\u003eSenior high school\u003c/p\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e56/187 (29.95)\u003c/p\u003e\n \u003cp\u003e17/187 (9.09)\u003c/p\u003e\n \u003cp\u003e30/187 (16.04)\u003c/p\u003e\n \u003cp\u003e63/187 (33.69)\u003c/p\u003e\n \u003cp\u003e21/187 (11.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.47058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSelf-complete\u003c/p\u003e\n \u003cp\u003eReading the question\u003c/p\u003e\n \u003cp\u003eWriting down the given answer\u003c/p\u003e\n \u003cp\u003eTranslating the question into local language\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e143\u0026nbsp;(75.66)\u003c/p\u003e\n \u003cp\u003e43 (22.75)\u003c/p\u003e\n \u003cp\u003e25 (13.23)\u003c/p\u003e\n \u003cp\u003e4 (2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eThe ceiling and floor effects are shown in Table \u003cspan\u003e2\u003c/span\u003e. All the 10-point global rating scales (Q8, Q32, and Q35) exhibited significant ceiling effects (ranging from 39.89 to 48.91%). Ceiling effects were also observed in most composites of the NCC and QoC domains, with exceptions noted for \u0026ldquo;Q24 staff manage problem\u0026rdquo; (12.07%) and \u0026ldquo;Q43 satisfied with way problems handled\u0026rdquo; (1.14%). None of the questions demonstrated significant floor effects (0\u0026ndash;13.89%).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCeiling and floor of the Thai CAHPS-ICH\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eThai CAHPS-ICH\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 month\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%Ceiling effect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%Floor effect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%Ceiling effect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%Floor effect\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ3 Doctor listens carefully\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ4 Doctor explains things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ5 Doctor shows respect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ6 Doctor spends enough time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ7 Doctor cared about you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ8 Nephrologists\u0026rsquo; communication and caring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ10 Staff listen carefully\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ11 Staff explain in a way that is easy to understand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ12 Staff show respect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ13 Staff spend enough time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ14 Staff cared about you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ15 Staff makes you comfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ21 Staff insert needle without pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ22 Staff check you closely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ24 Staff manage problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ25 Staff professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ27 Staff explain tests\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ32 Quality of Dialysis Center Care and Operations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ33 On machine within 15 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ34 Center clean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ35 Providing Information to Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ43 Satisfied with way problems handled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable \u003cspan\u003e3\u003c/span\u003e displays the results of the validity assessment, presenting the correlations between survey domains and global rating scales. The NCC domain demonstrated a strong association with the global rating scale of nephrologists (r\u0026thinsp;=\u0026thinsp;0.60). Similarly, the QoC scale exhibited a strong association with the global rating scales of staff and center (r\u0026thinsp;=\u0026thinsp;0.65 and r\u0026thinsp;=\u0026thinsp;0.58, respectively). Additionally, a moderate association was observed between the PI scale and center global rating scale (r\u0026thinsp;=\u0026thinsp;0.31).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCorrelations between Scales and Global Rating Scales\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale domains\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003cp\u003erating scale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStaff\u003c/p\u003e\n \u003cp\u003erating scale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCenter\u003c/p\u003e\n \u003cp\u003erating scale\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrologists\u0026rsquo; Communication and Caring (NCC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQuality of Dialysis Center Care and Operations (QoC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding Information to Patients (PI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAll correlations are significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe correlations between each multi-item scale and all three global rating scales are outlined in Table \u003cspan\u003e4\u003c/span\u003e. Five out of six items from the NCC domain demonstrated a strong correlation with the doctor global rating scale (r\u0026thinsp;=\u0026thinsp;0.51\u0026ndash;0.58). Additionally, ten out of 17 items in the QoC domain were associated with the staff and center rating scales (r\u0026thinsp;=\u0026thinsp;0.45\u0026ndash;0.59 and r\u0026thinsp;=\u0026thinsp;0.34\u0026ndash;0.55, respectively). However, no correlation was detected between the PI domain and any of the global rating scales.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eItem-scale correlations of the Thai CAHPS-ICH composites\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eScales\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDoctor rating\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStaff rating\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCenter rating\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ3 Doctor listens carefully (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e\n \u003cp\u003eQ4 Doctor explains things (n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\n \u003cp\u003eQ5 Doctor shows respect (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ6 Doctor spends enough time (n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\n \u003cp\u003eQ7 Doctor cared about you (n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\n \u003cp\u003eQ9 Doctor seemed informed (n\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.58\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.42\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.44\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.37\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.48\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.43\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.41\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.42\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ10 Staff listen carefully (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003cp\u003eQ11 Staff explain in a way that is easy to understand (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003cp\u003eQ12 Staff show respect (n\u0026thinsp;=\u0026thinsp;172)\u003c/p\u003e\n \u003cp\u003eQ13 Staff spend enough time (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ14 Staff cared about you (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003cp\u003eQ15 Staff makes you comfortable (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ16 Staff keep information private (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\n \u003cp\u003eQ17 Comfortable asking staff (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ21 Staff insert needle without pain (n\u0026thinsp;=\u0026thinsp;171)\u003c/p\u003e\n \u003cp\u003eQ22 Staff check you closely (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ24 Staff manage problems (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\n \u003cp\u003eQ25 Staff professional (n\u0026thinsp;=\u0026thinsp;170)\u003c/p\u003e\n \u003cp\u003eQ26 Staff discuss diet (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003cp\u003eQ27 Staff explain tests (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e\n \u003cp\u003eQ33 On machine within 15 min (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003cp\u003eQ34 Center clean (n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e\n \u003cp\u003eQ43 Satisfied with way problems handled (n\u0026thinsp;=\u0026thinsp;167)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.33\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.39\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.38\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.34\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.37\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003e0.33\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003cp\u003e0.33\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.24\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.34\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.33\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.59\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.51\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.57\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003cp\u003e0.16\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003cp\u003e0.47\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.25\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.49\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.25\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.46\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.27\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.44\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.48\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.39\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.42\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.46\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003cp\u003e0.47\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003cp\u003e0.34\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003cp\u003e0.37\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.25\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e0.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ19 Know how to care of access site (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ28 Staff give information on patient rights (n\u0026thinsp;=\u0026thinsp;169)\u003c/p\u003e\n \u003cp\u003eQ29 Staff review patient rights (n\u0026thinsp;=\u0026thinsp;167)\u003c/p\u003e\n \u003cp\u003eQ30 Staff told you what to do if health problem at home\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e\n \u003cp\u003eQ31 Staff told you how to get off machine if emergency (n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e\n \u003cp\u003eQ36 Doctor/staff talk about which treatment is right for you\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;165)\u003c/p\u003e\n \u003cp\u003eQ38 Doctor/staff explain why not eligible for transplant (n\u0026thinsp;=\u0026thinsp;171)\u003c/p\u003e\n \u003cp\u003eQ39 Doctor/staff talk about peritoneal dialysis (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\n \u003cp\u003eQ40 Involved in choosing treatment (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003cp\u003e-0.25\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.30\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003cp\u003e-0.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.30\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.31\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.24\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003cp\u003e-0.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.21\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.32\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003cp\u003e-0.21\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003ep \u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFor internal consistency reliability, the composites of the Nephrologists\u0026rsquo; Communication (6 items) and Quality of Dialysis Center Care and Operations (17 items) domains exhibited good and acceptable reliability (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.86 and 0.78, respectively). However, the PI composite did not demonstrate internal consistency (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.53). (Table 5)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eInternal Consistency Reliability\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDomains\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCronbach\u0026rsquo;s alpha (\u0026alpha;)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrologists\u0026rsquo; Communication and Caring (6 items)\u003c/p\u003e\n \u003cp\u003eQuality of Dialysis Center Care and Operations (17 items)\u003c/p\u003e\n \u003cp\u003eProviding Information to Patients (9 items)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMost of the multi-item scales exhibited test-retest repeatability (intraclass correlation coefficient; ICC, 0.55\u0026ndash;0.85). However, one multi-item scale (Q43 Satisfied with way problems handled) did not demonstrate this reliability (ICC\u0026thinsp;=\u0026thinsp;0.19). Test-retest reliability was observed for 4 out of the 13 yes/no questions, all of which are in the PI domain (Q29, Q30, Q31, and Q38) as shown in Table \u003cspan\u003e6\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eIntraclass correlation\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ3 Doctor listens carefully\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u0026ndash;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ4 Doctor explains things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u0026ndash;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ5 Doctor shows respect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u0026ndash;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ6 Doctor spends enough time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u0026ndash;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ7 Doctor cared about you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40\u0026ndash;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ8 Nephrologists\u0026rsquo; communication and caring\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u0026ndash;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ9 Doctor seemed informed\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u0026ndash;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ10 Staff listen carefully\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u0026ndash;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ11 Staff explain in a way that is easy to understand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u0026ndash;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ12 Staff show respect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u0026ndash;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ13 Staff spend enough time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u0026ndash;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ14 Staff cared about you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026ndash;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ15 Staff makes you comfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026ndash;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ16 Staff keep information private\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.07\u0026ndash;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ17 Comfortable asking staff\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.44\u0026ndash;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ21 Staff insert needle without pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u0026ndash;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ22 Staff check you closely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u0026ndash;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ24 Staff manage problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u0026ndash;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ25 Staff professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026ndash;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ26 Staff discuss diet\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u0026ndash;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ27 Staff explain tests\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026ndash;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ32 Quality of Dialysis Center Care and Operations\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u0026ndash;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ33 On machine within 15 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u0026ndash;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ34 Center clean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u0026ndash;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ35 Providing Information to Patients\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u0026ndash;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ43 Satisfied with way problems handled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.12\u0026ndash;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ19 Know how to care of access site\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u0026ndash;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ28 Staff give information on patient rights\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.19\u0026ndash;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ29 Staff review patient rights\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u0026ndash;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ30 Staff told you what to do if health problem at home\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u0026ndash;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ31 Staff told you how to get off machine if emergency\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u0026ndash;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ36 Doctor/staff talk about which treatment is right for you\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u0026ndash;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ38 Doctor/staff explain why not eligible for transplant\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u0026ndash;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ39 Doctor/staff talk about peritoneal dialysis\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u0026ndash;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQ40 Involved in choosing treatment\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u0026ndash;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eYes/No question\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eGlobal rating scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eWe compared the results of our \u0026ldquo;Thai CAHPS-ICH\u0026rdquo; survey and the original ICH-CAHPS\u0026reg; survey in Table \u003cspan\u003e7\u003c/span\u003e. The response rate in our study was higher than that of the original survey (80.43% vs. 46%). Both surveys demonstrated internal consistency in the NCC and QoC domains (⍺ = 0.86 and 0.78 in the Thai CAHPS-ICH survey, and ⍺ = 0.81 and 0.90 in the ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e survey, respectively). However, neither survey showed internal consistency in the PI domain (⍺ = 0.53 in the Thai CAHPS-ICH survey and ⍺ = 0.55 in the ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e survey). Regarding validity, both surveys exhibited correlations between the NCC domain and the doctor rating scale (r\u0026thinsp;=\u0026thinsp;0.60 and 0.78 in the Thai CAHPS-ICH and original ICH-CAHPS\u0026reg; surveys, respectively), between the QoC domain and the staff rating scale (r\u0026thinsp;=\u0026thinsp;0.65 and 0.75 in the Thai CAHPS-ICH and original ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e surveys, respectively), and between the QoC and the center rating scale (r\u0026thinsp;=\u0026thinsp;0.58 and 0.69 in the Thai CAHPS-ICH and original ICH-CAHPS\u0026reg; surveys, respectively). However, both surveys showed less strong correlations between the PI domain and all global rating scales.\u003c/p\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003c/table\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab12\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 7\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison between the Thai CAHPS-ICH and original ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e(\u003cspan\u003e5\u003c/span\u003e, \u003cspan\u003e17\u003c/span\u003e)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eContents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eThai CAHPS-ICH\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOriginal ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy design (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle center study in Chiang Mai (n\u0026thinsp;=\u0026thinsp;189)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMulticenter study in US (n\u0026thinsp;=\u0026thinsp;819)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQuestionnaire form\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTelephone or mailed survey\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReliability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e⍺\u003csup\u003e1\u003c/sup\u003e = 0.86 (NCC),\u003c/p\u003e\n \u003cp\u003e0.78 (QoC),\u003c/p\u003e\n \u003cp\u003e0.53 (PI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e⍺\u003csup\u003e1\u003c/sup\u003e = 0.81 (NCC),\u003c/p\u003e\n \u003cp\u003e0.90 (QoC),\u003c/p\u003e\n \u003cp\u003e0.55 (PI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eValidity(r)\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- 0.60 between NCC and Doctor GRS\u003c/p\u003e\n \u003cp\u003e- 0.65 between QoC and Staff GRS\u003c/p\u003e\n \u003cp\u003e- 0.58 between QoC and Center GRS\u003c/p\u003e\n \u003cp\u003e- \u0026lt;\u0026thinsp;0.5 between PI domain and all GRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- 0.78 between NCC and Doctor GRS\u003c/p\u003e\n \u003cp\u003e- 0.75 between QoC and Staff GRS\u003c/p\u003e\n \u003cp\u003e- 0.69 between QoC and Center GRS\u003c/p\u003e\n \u003cp\u003e- \u0026lt;\u0026thinsp;0.5 between PI domain and all GRS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eCronbachs\u0026rsquo; alpha coefficient\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eCorrelation coefficient (r) of value\u0026thinsp;\u0026ge;\u0026thinsp;0.3 and \u0026ge;\u0026thinsp;0.4 were considered association for Thai CAHPS-ICH and for Original ICH-CAHPS respectively.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis was the first study to develop and evaluate our \u0026ldquo;Thai CAHPS-ICH\u0026rdquo; survey for MHD patients in Thailand. Given the scarcity of evidence on patient experience and care quality within this context, we aimed to investigate the correlation between care quality and patient outcomes. As the first phase of our project, we intended to verify that the survey could project the details of the quality of care. Our findings indicate that the \"Thai CAHPS-ICH\" survey demonstrates construct validity and achieves acceptable to good internal consistency reliability.\u003c/p\u003e \u003cp\u003eThe ceiling effects were significant across all three global rating scales and the majority of multi-item scales, except for Q24 and Q43. Conversely, the floor effects were minimal. These ceiling effects were consistent with those observed in the original ICH-CAHPS\u0026reg; survey, ranging from 15% in the QoC composite to 75% in the kidney doctor global rating.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) These findings may be attributed to the good quality of care provided by our academic hemodialysis facility.\u003c/p\u003e \u003cp\u003eIn assessing the construct validity of this survey, we observed large associations between the NCC domain and the kidney doctor rating scale, the QoC domain and staff rating scale, as well as the QoC domain and center rating scale. These findings indicate that the expected measure within each domain correlated with the intended aspects of assessment. The strongest correlations within each domain were similar to those found in the original survey.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) However, the PI domain, aimed at evaluating patients\u0026rsquo; understanding of the information provided by nephrologists or dialysis staff, did not exhibit a significant correlation with any global rating scale. This negative result might be because none of the three global rating scales were specifically designed to assess this aspect.\u003c/p\u003e \u003cp\u003eIn evaluating the internal consistency and test-retest reliabilities of the Thai CAHPS-ICH survey, we found that the NCC and QoC domains exhibited good and acceptable internal consistency reliability, respectively. These results correspond with those of the original ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e survey.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) However, similar to the original ICH-CAHPS\u003csup\u003e\u0026reg;\u003c/sup\u003e survey, the PI domain did not demonstrate internal consistency.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Potential reasons for this outcome could include the heterogeneous nature of the questions within this domain and variations in patients' levels of literacy.\u003c/p\u003e \u003cp\u003eOur study had several strengths. First, our survey represented the first Patient-Reported Outcome Measure for maintenance hemodialysis patients in Thailand, and we expected that this survey could be used to assess the quality of care among hemodialysis centers in Thailand. Second, we recruited all patients from a single dialysis center, which confirmed that the results apparently reflected the quality of care provided by the individual hemodialysis facility. However, our study also had some limitations. First, because of the absence of validated PREMs for Thai MHD patients, the comparison of each domain with its own components was not directly validated. Therefore, our survey had to validate each domain with 3 global rating scales. Second, this was a single-center study that could not be generalized to other hemodialysis centers in Thailand. Therefore, further studies evaluating the generalizability of this survey and the relationship between the survey score and clinical outcomes (e.g., laboratory parameters, health-related quality of life, hospitalization, mortality) are warranted.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Thai version of the Consumer Assessment of Health Care Providers and Systems In-Center Hemodialysis, or \"Thai CAHPS-ICH\" survey, demonstrates reliability and validity among patients undergoing maintenance hemodialysis at Maharaj Nakorn Chiang Mai Hospital. This survey holds potential for application in other hemodialysis facilities across Thailand.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; The authors thank David I. Lewin, the Health Communications Specialist/Manager of Copyrights \u0026amp; Permissions, Agency of Healthcare Research and Quality, who is responsible for the international requests for the CAHPS survey usage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received support from a grant provided by the Faculty of Medicine, Chiang Mai University. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; This study was reviewed and approved by the Ethics Committee of Chiang Mai University (approbation number: MED-2565-09133)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Was waived by the Ethics Committee of Chiang Mai University (approbation number: MED-2565-09133) as it was a prospective observational study with data from the survey and medical electronic records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; All authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKanjanabuch T, Takkavabtakarn K. Global Dialysis Perspective: Thailand. Kidney360. 2020;1(7):671-5.\u003c/li\u003e\n\u003cli\u003eNissenson AR. Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm. Clinical Journal of the American Society of Nephrology. 2014;9(2):430-4.\u003c/li\u003e\n\u003cli\u003eNair D, Wilson FP. Patient-Reported Outcome Measures for Adults With Kidney Disease: Current Measures, Ongoing Initiatives, and Future Opportunities for Incorporation Into Patient-Centered Kidney Care. American Journal of Kidney Diseases. 2019;74(6):791-802.\u003c/li\u003e\n\u003cli\u003eAiyegbusi OL, Kyte D, Cockwell P, Anderson N, Calvert M. A patient-centred approach to measuring quality in kidney care: patient-reported outcome measures and patient-reported experience measures. Curr Opin Nephrol Hypertens. 2017;26(6):442-9.\u003c/li\u003e\n\u003cli\u003eWood R, Paoli CJ, Hays RD, Taylor-Stokes G, Piercy J, Gitlin M. Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey. Clin J Am Soc Nephrol. 2014;9(6):1099-108.\u003c/li\u003e\n\u003cli\u003eIn-Center Hemodialysis CAHPS Survey. National Implementation [Available from: https://ichcahps.org/General-Information/National-Implementation.\u003c/li\u003e\n\u003cli\u003eIn-Center Hemodialysis CAHPS Survey. Survey and Protocols [cited 2023 27th March]. Available from: https://ichcahps.org/Survey-and-Protocols.\u003c/li\u003e\n\u003cli\u003eDad T, Tighiouart H, Lacson E, Meyer KB, Weiner DE, Richardson MM. Hemodialysis patient characteristics associated with better experience as measured by the In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. BMC Nephrology. 2018;19(1):340.\u003c/li\u003e\n\u003cli\u003ePsychometric Evaluation of the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey. American Journal of Kidney Diseases. 2019;73(5):667.\u003c/li\u003e\n\u003cli\u003eContextualizing the Interpretation of ICH-CAHPS Scores as a Measure of the Experience of Care of Dialysis Patients. American Journal of Kidney Diseases. 2019;73(5):739-40.\u003c/li\u003e\n\u003cli\u003eDad T, Grobert ME, Richardson MM. Using Patient Experience Survey Data to Improve In-Center Hemodialysis Care: A Practical Review. American Journal of Kidney Diseases. 2020;76(3):407-16.\u003c/li\u003e\n\u003cli\u003eBeaton D, Bombardier C, Guillemin F, Ferraz M. Recommendations for the Cross-Cultural Adaptation of the DASH \u0026amp; QuickDASH Outcome Measures Contributors to this Document. Institute for Work \u0026amp; Health. 2007;1.\u003c/li\u003e\n\u003cli\u003eVega A, Abad S, Verdalles \u0026Uacute;, Aragoncillo I, Vel\u0026aacute;zquez K, Quiroga B, et al. Dose equivalence between continuous erythropoietin receptor activator (CERA), Darbepoetin and Epoetin in patients with advanced chronic kidney disease. Hippokratia. 2014;18 4:315-8.\u003c/li\u003e\n\u003cli\u003eCohen J. Statistical Power Analysis for the Behavioral Sciences. 2 ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. p. 77-81.\u003c/li\u003e\n\u003cli\u003ePerinetti G. StaTips Part IV: Selection, interpretation and reporting of the intraclass correlation coefficient. South European Journal of Orthodontics and Dentofacial Research. 2018;5.\u003c/li\u003e\n\u003cli\u003eWalter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101-10.\u003c/li\u003e\n\u003cli\u003eWeidmer BA, Cleary PD, Keller S, Evensen C, Hurtado MP, Kosiak B, et al. Development and evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey for in-center hemodialysis patients. Am J Kidney Dis. 2014;64(5):753-60.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient-reported experience measure, maintenance hemodialysis, Thai CAHPS-ICH survey","lastPublishedDoi":"10.21203/rs.3.rs-4300017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4300017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatient-reported experience measures (PREMs) are important tools for evaluating the quality of care from patients' perspectives. Nevertheless, no validated PREMs exist for maintenance hemodialysis (MHD) patients in Thailand. This study aimed to develop a Thai version of the Consumer Assessment of Healthcare Providers and System In-center Hemodialysis (CAHPS-ICH) survey and assess its validity and reliability.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe translated the original CAHPS-ICH\u003csup\u003e\u0026reg;\u003c/sup\u003e survey into Thai and administered it to MHD patients at the hemodialysis center of Chiang Mai University Hospital. Correlation analysis was employed to evaluate the construct validity of each domain (Nephrologists\u0026rsquo; communication and caring [NCC], quality of dialysis center cares and operation [QoC] and providing information to patients [PI]) and the global rating scales. Internal consistency and test-retest reliability were assessed using Cronbach's alpha coefficient (α) and intraclass correlation coefficient (ICC), respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 189 patients were recruited. The NCC domain exhibited the strongest correlation with the doctor global rating scale (r\u0026thinsp;=\u0026thinsp;0.60) and displayed good internal consistency (α\u0026thinsp;=\u0026thinsp;0.86). The QoC domain indicated positive correlations with the staff and center rating scales (r\u0026thinsp;=\u0026thinsp;0.65 and 0.58, respectively) and demonstrated acceptable internal consistency (α\u0026thinsp;=\u0026thinsp;0.78). The PI domain showed a moderate association with the center global rating scales (r\u0026thinsp;=\u0026thinsp;0.31), but its internal consistency was not demonstrated (α\u0026thinsp;=\u0026thinsp;0.53). Most multi-item scale questions showed satisfactory test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.50\u0026ndash;0.85).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe \u0026ldquo;Thai CAHPS-ICH\u0026rdquo; survey proves to be a valid and reliable tool for assessing the patient experience among MHD patients at Chiang Mai University Hospital.\u003c/p\u003e","manuscriptTitle":"Validity and Reliability of the Thai Version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) Survey for Maintenance Hemodialysis Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 19:17:45","doi":"10.21203/rs.3.rs-4300017/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-21T15:30:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T07:52:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-18T14:34:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-18T08:17:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335784674149043601069435407185916703279","date":"2025-05-15T03:12:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243354212475266379058126063026341242240","date":"2025-05-08T11:10:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178231843719556171656282916407918406087","date":"2025-05-07T21:06:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-13T05:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272099711963976830451847029281315081520","date":"2025-04-03T13:14:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114085586257909707446094232111116992859","date":"2025-04-03T03:40:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191966012650082768549750124484502897971","date":"2024-11-15T22:59:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311236552514908118863152756827062068160","date":"2024-09-25T06:21:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74695938611560865539700997378094838745","date":"2024-08-05T06:40:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165412104886100297254403067831817907927","date":"2024-08-02T19:19:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-01T10:43:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91953233036710469260246779462075966480","date":"2024-08-01T07:17:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-06T15:53:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-05T07:08:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-30T05:18:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-30T05:14:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-04-21T08:47:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b51deb6c-92e9-4644-a338-3ba0413c9c2a","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T07:10:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 19:17:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4300017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4300017","identity":"rs-4300017","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}