Content Validity of Patient-Reported Measures Evaluating Experiences of the Quality of Transitions in Healthcare Settings - A Scoping Review.

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Sisse Walløe, Stine Gundtoft Roikjær, Sebrina Maj-Britt Hansen, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4211885/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jul, 2024 Read the published version in BMC Health Services Research → Version 1 posted 4 You are reading this latest preprint version Abstract No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients’ experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing PREMs, and evaluate the PREMs’ content validity. The methods was guided by the Joanna Briggs Institutes’ guidance for scoping reviews. The search was performed on 07 December 2021, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 16,134 publications, and 172 studies were included for review. We identified 29 PREMs assessing at least one aspect of adults’ experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid. Healthcare transitions Patient-Reported Experience Measure Patient Experience Quality Scoping Review Figures Figure 1 Figure 2 Figure 3 Background Care management encompasses evaluating individuals' needs and coordinating healthcare services; however, patients struggle with consistency and clarity in care management. 1 Patients’ ability to navigate healthcare systems has implications for the outcome of their treatment 2,3 , and patients’ experiences are associated with clinical effectiveness and safety. 4 Therefore, assessing patients’ experiences with transitions in healthcare is important in determining the quality of healthcare delivery. Patient-reported experience measures (PREM) are intended to be reliable measures of the quality of healthcare services from patients’ perspectives and may support evaluation of the effectiveness, safety, and efficiency of healthcare provision. 5 Several reviews of instruments measuring patient experience of the quality in healthcare transitions have been published. 6–11 In the systematic review by Berbee et al. (2009) they aimed to identify and select an appropriate instrument for measuring the quality of integrated care for patients experiencing chronic illness, but identified no patient-reported experience measure (PREM) that was comprehensive or relevant according to focus group interviews with the patients. 6 Concordantly, in a systematic review for evaluating patient satisfaction in healthcare settings integrating behavioural and medical health services, Black et al. (2021) found that no PREM comprehensively captured all relevant aspects of the integrated healthcare experience. 7 In contrast, Weaver et al. (2017) reviewed concepts, models, and instruments for understanding care continuity in mental health services and suggested a PREM suitable for self-reporting experiences with mental healthcare. 8 In 2011 Fiscella et al. (2011) published a consensus of domains and measures suitable for patient-reported assessment of cancer navigation but also called for an instrument that covered all relevant topics. 9 Likewise, McMurray et al. (2016) identified 25 instruments to assess patients’ experience of rehabilitation services, but none comprehensively measured patient experience across the rehabilitative care continuum. 10 Following this, Quinn et al. (2017) concluded that no instruments adequately assessed veterans’ experience with access and coordination across healthcare settings. 11 No reviews so far have identified a generic PREM that comprehensively measures patients’ experience with the quality of healthcare transitions. 6–13 Therefore, there is a need to identify adequate concepts and measures that can target the patient experience transition in healthcare. The COSMIN group argues that content validity is the most important aspect of patient-reported measures. 14 Content validity refers to a patient-reported measure's relevance, comprehensiveness, and comprehensibility. 15 In other words, to evaluate whether the instrument provides an adequate reflection of the construct to be measured in the context. 14 Although there is some consensus on defining patient experience of healthcare transitions as a multidimensional concept consisting of human-relational and system factors, the conceptualizations found in existing reviews still lack clarity. 6–13 The overall scope of this review was to explore and define domains of the concept of patient-experienced quality in cross-sectoral care for generic patient populations. Further, to map existing methods for generically assessing the quality of transitions in healthcare settings (e.g. between municipality, general practitioner, and hospital). To achieve this, our objectives were: What domains are considered relevant to measure for patients’ experiencing healthcare transitions when evaluating the quality of care they have received? What existing patient-reported experience measures attempt to measure patients’ experience of transitions in healthcare settings? Are any existing patient-reported experience measures adequate (relevant and comprehensive) reflections of patients’ experience of transitions in healthcare settings? Methods The method of this scoping review followed the Joanna Briggs Institutes’ (JBI) guidance for scoping reviews. 16 The article was outlined following JBI guidelines 16 supported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. 17 A pre-registered protocol, including aims, search strategies, and amendments made during the iterative review process 16 , is available via Open Science Framework (OSF). 18 The research question was defined using the SPIDER-model (i.e., Setting, Phenomenon of Interest, Design, Evaluation, Research). 19 The research question encompassed five concepts with predefined definitions and in- and exclusion criteria to ensure identification of eligible studies ( Table 1 ). Table 1 - Research Question Defined by the SPIDER-Model Concepts Inclusion criteria Exclusion criteria S Setting Transitions in healthcare settings Patient transition between at least 2 healthcare settings (municipality, GP, hospital) Single settings such as “In the primary care setting, at the hospital etc.” PI Phenomenon of Interest Patient-experienced quality Patients’ experiences were accounted for or assessed Only healthcare personnel or relatives’ experiences were assessed D Design Qualitative and quantitative research designs. Psychometric studies qualitative studies, quantitative studies, syntheses/reviews Feasibility studies, study protocols, reports E Evaluation PREMs*, patient accounts, narratives, attitudes, perspectives, and experiences of quality. Patient experience of healthcare provision 10,20 Patient satisfaction 21 R Research Type Published, peer-reviewed research reporting data Peer-reviewed, published studies Conference abstracts and meeting notes *Patient-Reported Experience Measure Search The search was performed on 07 December 2021. The electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO) were chosen because they cover multiple research areas within healthcare. The search was developed in Embase and translated to Medline and Cinahl as recommended. 22 For the phenomenon of interest, we identified the Mesh term “Patient Satisfaction”. Although we excluded studies reporting on patient satisfaction rather than patient experience, the terms have been used interchangeably, 10 and patient satisfaction thus seemed necessary to include in our search strategy. As the focus on patient's experiences of coherent care seemed to have emerged around late 1990 and early 2000, 23 we searched for literature from 2000. The search strategy was developed from the predefined definitions and criteria with guidance from research librarians ( see full search strategy in Appendix 1 ). Selection of Sources of Evidence Covidence (Veritas Health Innovation, Melbourne, Australia) was used to manage the duplication and screening process. 24 All studies were screened by two independent reviewers, and a total of seven reviewers participated in the screening process. To ensure calibration of the screening process, a consensus meeting was arranged at the beginning of the process as in rapid reviews. 25 During the calibration sessions, in- and exclusion criteria were specified further than the a-priori defined criteria ( Appendix 2 ). In the full-text screening process, we experienced a larger number of articles than expected. In order to focus this review on the a priori defined aims, we decided to; I) report on intervention studies in an independent review, II) exclude mixed-methods studies and original qualitative studies, III) synthesize dimensions found in the included syntheses and reviews rather than report on the original studies. We decided to include syntheses and reviews because reports on qualitative studies were frequent, and relevant themes for patient-experienced quality of healthcare transitions had already been mapped in these meta-syntheses, integrative reviews, or scoping reviews. Data Charting Process A priori-defined data extraction templates were used and are available at OSF. 26 The data charting was done by one author (SW). The first 10 data extractions were validated independently by a research assistant (NH). The data charting table and process were adapted following the pilot extraction. The final data extraction tables are available in Appendix 3 and Appendix 4. Critical Appraisal of Individual Sources of Evidence Although the JBI guidelines for scoping reviews do not warrant critical appraisal, 27 comprehensive (i.e. PREMs including at least five items of the 12 subthemes). PREMs were critically appraised according to the COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures 14,28,29 to assess content validity 14 (relevance, comprehensiveness, and comprehensibility) from patients’ perspectives. The critical assessment was done independently by two reviewers (SW, LM), and conflicts were discussed until a consensus was reached. When PREMs were mentioned in included publications but not available in the publication, references were followed to the original publications on that PREM. Synthesis of Results We synthesized the data by; I) Summarizing themes identified in the qualitative syntheses and identifying relevant domains ( Appendix 3 and Figure 3 ); II) Identifying PREMs, assessing the PREMs phenomenon of interest, and categorizing and listing the items of the relevant PREMs to assess comprehensiveness ( Appendix 4, Appendix 5 and Table 2 ); III) Assessing the content validity of the most comprehensive PREMs (items related to five or more themes) ( Table 2 ). The process of synthesizing data is also described in figure 1. Figure 1 – Data Synthesis Process Results The search identified 16,134 records ( Figure 2 ), and 172 reports were included after the screening and selection process ( Figure 2 ). In addition to the regular selection process, first author SW divided the reports according to objectives 1 (24 reports) and 2 (148 reports, 35 reports excluded during data extraction, leaving 113 reports for inclusion). This was done because the scientific methods for reports to answer objective 1 needed to be qualitative, and the methods relevant for answering objective 2 needed to be quantitative observational, development, or validation reports. Figure 2 – PRISMA Flowchart Relevant Domains (Results for Objective 1) For objective one, we included 24 reports ( Appendix 6 ), 30–53 which included: 10 (42%) systematic reviews, 34,36,37,40,43,44,46,47,49,51 six (25%) scoping reviews, 32,38,41,48,50,53 Four (17%) meta syntheses, 30,39,52 three (13%) integrated reviews, 33,35,42 one (4%) narrative review, 54 and one (4%) qualitative review 45 that provided information on relevant domains and/or themes for assessing patients´ experiences with care across healthcare settings. The number of identified themes ranged from two 32 to 13, 50 with most articles reporting three themes. 34,39,52,53 When summarizing and describing themes from the included reports, we found that the themes could be organized in two distinct domains; I) A system/organizational domain; II) A human-relational domaine. Each of these domains encompassed six themes; thus, we identified 12 relevant themes as illustrated in Figure 3. Figure 3 – Domains, Themes, and Items Relevant for Assessing Patients’ Experiences of Pathways Across Healthcare Settings. Existing Patient-Reported Experience Measures (Results for Objective 2) For objective two, we included 113 ( Appendix 6 ) 6–13,55–159 reports that described 109 unique PREMs ( Appendix 4 ). However, 80 (73%) PREMs were excluded during data extraction as they referred to other aspects of care quality than transitions between healthcare settings or otherwise deviated from our specified phenomenon ( Appendix 5 ). The Consumer Assessment of Healthcare Providers and Systems (CAHPS) 160–163 questionnaires were most frequently referred to, 6,7,9,11,56,61,63,66 but we did not find the items relevant according to the construct definition in objective 1. The two relevant PREMs that were most frequently referred to were Nijmegen Continuity Questionnaire 8,12,72,77,105,119,151,152 and Patient Assessment of Chronic Illness Care (PACIC). 6,11,12,78,80,85,109,112,164 In the data extraction process, we identified different ways of formulating items. Some items were worded from a medical system perspective on quality i.e. “My physical pain was controlled as well as possible”, 165 whereas others were articulated from a patient-centred perspective i.e. “My treatment fits my needs”. 124 Yet, other items were specific to a certain contextual system infrastructure i.e. “The specialist makes out the first prescription for the treatment he/she prescribes me”, 95 or they were disease-specific. 114 However, we did identify PREMs with a more generic wording such as, “Were there times when you had to repeat information that should have been in your care records?”. 166 Adequate reflection of patients’ experience (results for objective 3) We extracted 29 PREMs that pertained to patient-experience of quality of transitions in healthcare settings. To assess the relevance and comprehensiveness of the identified PREMs, the items of each PREM were plotted according to the 12 subthemes identified for objective 1 ( table 2 ). Twenty-one PREMs had items related to at least five of the 12 subthemes ( table 2 ). To focus our review on the most comprehensive PREMs, we critically appraised the selected 21 PREMs. The Alberta Continuity of Services Scale – Mental Health (ACSS-MH), 124 the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ), 148 and the Patient Experience of Integrated Care Scale (PEICS) 123 had adequate content validity, however, they were disease-specific and/or did not have items in all themes identified in objective 1 ( table 2 ). The remaining 16 PREMs had doubtful or inadequate content validity. Table 2 – Comprehensiveness and Content Validity of Existing PREMs for Assessment of Patients’ Experiences of the Quality of Transitions in Healthcare Settings. Discussion The overall aim of this scoping review was to define the concept of patient-experienced quality in healthcare transitions and map existing content valid PREMs relevant for measuring this concept. We found the construct of patient-reported experience of transitions in healthcare to consist of two domains – system/organization and human-relation. However, in summarizing the 24 qualitative reports for this review, we found some inconsistency and lack of clarity in the conceptualization and understanding of patient-experienced quality in healthcare transitions. Although some reports identified the construct of patient-experienced quality in healthcare transitions to consist of two main domains (organization and human-relational), 8,9,40,47,158 others disagreed 33,50 and leaned towards the Institute of Medicine’s framework for quality with five or more domains. 23 The two-dimensional model is, however, supported by both qualitative conceptualization 40,47 and testing of measurement properties, 8,9,158 whereas the Institiutes of Medicine’s framework is not. In addition to inconsistency in domains, there was a general inconsistency in the number and terminology for themes 32,50 and formulation of items concerning patient-centeredness. 124,165 As items in PREMs may be approached by respondents much the same as a dialogue, 167 we believe a person-centred approach to item formulation may provide the best opportunity for patients to assess quality of care appropriately. Several reports suggest further research into the conceptualization and understanding of patient-experience with care transitions. 32,36,49,54 Due to the variations in how the construct is defined, assessing the content validity of current PREMs becomes challenging. 14,15 Therefore, we support the suggestion of further research into the conceptualization of patient-experienced quality in healthcare transitions. We identified 29 PREMs that reflected at least one relevant aspect of the construct but none that were comprehensive reflections of generic patient populations’ experiences of transitions in healthcare settings. This finding aligns with the conclusion of the included reviews of instruments. 6–13,158,159 It is surprising that we have not identified a content-valid PREM given the large number of reports (113) and unique PREMs (109) included. This may be associated with the lack of clarity in the construct of patient-experienced quality in healthcare transitions. In the future, a generic PREM should be developed to make cross-comparison between studies and healthcare organizations possible. A collective effort to test and use a generice PREM might also support further development and/or understanding of the construct. This, however, would entail a generic approach to item formulation, as seen in P3CEQ, 166 rather than a context-specific approach. 95 It may be a limitation in our study that our search was imprecise with the inclusion of patient satisfaction in the search terms. However, the sensitivity of our search originates from inclusion of patient satisfaction in the search terms, and we consider the strength of this sensitivity to out way the imprecision by securing a comprehensive review. The comprehensiveness of our search resulted in a large number of records to be reviewed, and thus many reviewers to accommodate for time constraints. We attempted to compensate for a potentially low inter-rater reliability with calibration meetings. Despite of this, the number of reviewers may have been a limitation to the inclusion of all relevant, and only relevant reports. Furthermore, our pragmatic decision of excluding original qualitative studies from this review could have been a limitation to the comprehensiveness of our results. Incorporating the 24 qualitative reports has sufficiently advanced our comprehension of the existing literature to address objective 1. This is corroborated by the absence of new themes identified during data extraction from recent reports. The data extraction performed primarily by one reviewer may have caused some imprecision. However, as we have identified more PREMs than the included reviews of instruments, 6–13,158,159 this does not seem to be the case. While our scoping review does exhibit certain limitations, the thoroughness of our search and the inclusive methodology employed in comprehending and evaluating patient-experienced quality during healthcare transitions have nonetheless generated novel and significant insights. In light of our findings, it is plausible that items extracted from the most relevant and comprehensive PREMs, with a focus on generic formulations for infrastructure and disease, would reflect the construct of patient-experienced quality in healthcare transitions adequately. Furthermore, as there is some consensus that quality healthcare transitions occur when organisational structures are flexible and sensitive to patient preferences, 34,39–42,46,53 it seems advantageous to aply this knowledge in item extraction and/or formulation. As described, the construct seems to be unclear or imprecisely defined. Therefore, a process of extracting and/or formulating items should be undertaken systematically and iteratively with patient involvement and openness to re-evaluating the definition of the construct. A PREM revised by the outlined approach may support valid and reliable evaluation of the effectiveness, safety, and efficiency of healthcare provision. Conclusion In the literature, we identified several conceptual models that referred to aspects of patients’ experience with the quality of healthcare transitions. We consider a model with two domains likely to be adequate, however, a more comprehensive analysis and adequate definition of the construct is needed. Twenty-nine PREMs assessing at least one aspect of patients’ experience of transitions in healthcare were identified. However, none of the PREMs were considered content valid to measure patient-experienced quality in healthcare transitions generically. It is possible that items extracted from the identified questionnaires can be combined for a content-valid PREM. We call for further exploration into the construct of patient experience with healthcare transitions and testing of models to produce a content-valid PREM suitable for generic assessment of patients’ experiences with the quality of healthcare transitions. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, or publication of this article: This work was supported by the local research fund at Næstved, Slagelse, and Ringsted hospitals; by a program grant for Exercise First from Region Zealand; and a faculty scholarship from Department of Clinical Research at University of Southern Denmark. Authors’ contributions SW devised the systematic search and review process, contributed substantially to the data extraction and mapping process, and revised the manuscript critically. 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3","display":"","copyAsset":false,"role":"figure","size":399046,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDomains, Themes, and Items Relevant for Assessing Patients’ Experiences of Pathways Across Healthcare Settings.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure320230828.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/80dba3a9d709d478fbb9a61a.jpg"},{"id":61596973,"identity":"1d17cbd9-a100-4310-813d-112697d36101","added_by":"auto","created_at":"2024-08-01 17:30:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1933485,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/2e251808-9d53-46c6-ab0d-8a2dec8f32e9.pdf"},{"id":54594573,"identity":"2888e555-d604-4a78-963e-2ba2d82c673c","added_by":"auto","created_at":"2024-04-12 18:28:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21874,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/94953836bb3874a9a23af10c.docx"},{"id":54594594,"identity":"05156338-af19-48b4-945c-3cfb70faa1bd","added_by":"auto","created_at":"2024-04-12 18:28:33","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14871,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/a754e0bfe9165e53cecdc091.docx"},{"id":54594641,"identity":"d3dbce7e-c37d-4edd-b9d1-2afa3c75704e","added_by":"auto","created_at":"2024-04-12 18:28:43","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":72362,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix320230726.docx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/51927739b11bf22d775bbd65.docx"},{"id":54594605,"identity":"6f7fb94c-8890-41d4-8b2f-d2d82e76b1df","added_by":"auto","created_at":"2024-04-12 18:28:35","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":13410,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix420230726.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/1f50f07bbf8809eba6068e32.xlsx"},{"id":54594577,"identity":"c30e4ed9-1d44-4aed-9162-ed1dd5060e43","added_by":"auto","created_at":"2024-04-12 18:28:31","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":22249,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix5.docx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/bd928b4b6d0a41bb26c804ec.docx"},{"id":54594590,"identity":"aa246319-384c-4f34-b1ea-9427807e9752","added_by":"auto","created_at":"2024-04-12 18:28:33","extension":"pdf","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":298085,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix620230728.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/a9ce7905aa30d69f33a7c3d0.pdf"},{"id":54594564,"identity":"ed5b1064-1dc2-407c-ae07-f4a1c71c36b6","added_by":"auto","created_at":"2024-04-12 18:28:28","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":33615,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4211885/v1/dce2ec95cd4989fbde85832a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Content Validity of Patient-Reported Measures Evaluating Experiences of the Quality of Transitions in Healthcare Settings - A Scoping Review.","fulltext":[{"header":"Background","content":"\u003cp\u003eCare management encompasses evaluating individuals' needs and coordinating healthcare services; however, patients struggle with consistency and clarity in care management.\u003csup\u003e1\u003c/sup\u003e Patients\u0026rsquo; ability to navigate healthcare systems has implications for the outcome of their treatment\u003csup\u003e2,3\u003c/sup\u003e, and patients\u0026rsquo; experiences are associated with clinical effectiveness and safety.\u003csup\u003e4\u003c/sup\u003e Therefore, assessing patients\u0026rsquo; experiences with transitions in healthcare is important in determining the quality of healthcare delivery. Patient-reported experience measures (PREM) are intended to be reliable measures of the quality of healthcare services from patients\u0026rsquo; perspectives and may support evaluation of the effectiveness, safety, and efficiency of healthcare provision.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSeveral reviews of instruments measuring patient experience of the quality in healthcare transitions have been published.\u003csup\u003e6\u0026ndash;11\u003c/sup\u003e In the systematic review by Berbee et al. (2009) they aimed to identify and select an appropriate instrument for measuring the quality of integrated care for patients experiencing chronic illness, but identified no patient-reported experience measure (PREM) that was comprehensive or relevant according to focus group interviews with the patients.\u003csup\u003e6\u003c/sup\u003e Concordantly, in a systematic review for evaluating patient satisfaction in healthcare settings integrating behavioural and medical health services, Black et al. (2021) found that no PREM comprehensively captured all relevant aspects of the integrated healthcare experience.\u003csup\u003e7\u003c/sup\u003e In contrast, Weaver et al. (2017) reviewed concepts, models, and instruments for understanding care continuity in mental health services and suggested a PREM suitable for self-reporting experiences with mental healthcare.\u003csup\u003e8\u003c/sup\u003e In 2011 Fiscella et al. (2011) published a consensus of domains and measures suitable for patient-reported assessment of cancer navigation but also called for an instrument that covered all relevant topics.\u003csup\u003e9\u003c/sup\u003e Likewise, McMurray et al. (2016) identified 25 instruments to assess patients\u0026rsquo; experience of rehabilitation services, but none comprehensively measured patient experience across the rehabilitative care continuum.\u003csup\u003e10\u003c/sup\u003e Following this, Quinn et al. (2017) concluded that no instruments adequately assessed veterans\u0026rsquo; experience with access and coordination across healthcare settings.\u003csup\u003e11\u003c/sup\u003e No reviews so far have identified a generic PREM that comprehensively measures patients\u0026rsquo; experience with the quality of healthcare transitions.\u003csup\u003e6\u0026ndash;13\u003c/sup\u003e Therefore, there is a need to identify adequate concepts and measures that can target the patient experience transition in healthcare.\u003c/p\u003e\n\u003cp\u003eThe COSMIN group argues that content validity is the most important aspect of patient-reported measures.\u003csup\u003e14\u003c/sup\u003e Content validity refers to a patient-reported measure's relevance, comprehensiveness, and comprehensibility.\u003csup\u003e15\u003c/sup\u003e In other words, to evaluate whether the instrument provides an adequate reflection of the construct to be measured in the context.\u003csup\u003e14\u003c/sup\u003e Although there is some consensus on defining patient experience of healthcare transitions as a multidimensional concept consisting of human-relational and system factors, the conceptualizations found in existing reviews still lack clarity.\u003csup\u003e6\u0026ndash;13\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe overall scope of this review was to explore and define domains of the concept of patient-experienced quality in cross-sectoral care for generic patient populations. Further, to map existing methods for generically assessing the quality of transitions in healthcare settings (e.g. between municipality, general practitioner, and hospital). To achieve this, our objectives were:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003e\n\u003cp\u003eWhat domains are considered relevant to measure for patients\u0026rsquo; experiencing healthcare transitions when evaluating the quality of care they have received?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWhat existing patient-reported experience measures attempt to measure patients\u0026rsquo; experience of transitions in healthcare settings?\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAre any existing patient-reported experience measures adequate (relevant and comprehensive) reflections of patients\u0026rsquo; experience of transitions in healthcare settings?\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003cp\u003eThe method of this scoping review followed the Joanna Briggs Institutes\u0026rsquo; (JBI) guidance for scoping reviews.\u003csup\u003e16\u003c/sup\u003e The article was outlined following JBI guidelines\u003csup\u003e16\u003c/sup\u003e supported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.\u003csup\u003e17\u003c/sup\u003e A pre-registered protocol, including aims, search strategies, and amendments made during the iterative review process\u003csup\u003e16\u003c/sup\u003e, is available via Open Science Framework (OSF).\u003csup\u003e18\u003c/sup\u003e The research question was defined using the SPIDER-model (i.e., Setting, Phenomenon of Interest, Design, Evaluation, Research).\u003csup\u003e19\u003c/sup\u003e The research question encompassed five concepts with predefined definitions and in- and exclusion criteria to ensure identification of eligible studies (\u003cem\u003eTable 1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eTable 1 - Research Question Defined by the SPIDER-Model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.65109034267913%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003eConcepts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003eInclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003eExclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.049844236760125%\" valign=\"top\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.601246105919003%\" valign=\"top\"\u003e\n \u003cp\u003eSetting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003eTransitions in healthcare settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003ePatient transition between at least 2 healthcare settings (municipality, GP, hospital)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003eSingle settings such as \u0026ldquo;In the primary care setting, at the hospital etc.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.049844236760125%\" valign=\"top\"\u003e\n \u003cp\u003ePI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.601246105919003%\" valign=\"top\"\u003e\n \u003cp\u003ePhenomenon of Interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003ePatient-experienced quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u0026rsquo; experiences were accounted for or assessed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003eOnly healthcare personnel or relatives\u0026rsquo; experiences were assessed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.049844236760125%\" valign=\"top\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.601246105919003%\" valign=\"top\"\u003e\n \u003cp\u003eDesign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003eQualitative and quantitative research designs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003ePsychometric studies qualitative studies, quantitative studies,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003esyntheses/reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003eFeasibility studies, study protocols, reports\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.049844236760125%\" valign=\"top\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.601246105919003%\" valign=\"top\"\u003e\n \u003cp\u003eEvaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003ePREMs*, patient accounts, narratives, attitudes, perspectives, and experiences of quality.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003ePatient experience of \u0026nbsp;healthcare provision\u003csup\u003e10,20\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003ePatient satisfaction\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.049844236760125%\" valign=\"top\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.601246105919003%\" valign=\"top\"\u003e\n \u003cp\u003eResearch Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.98753894080997%\" valign=\"top\"\u003e\n \u003cp\u003ePublished, peer-reviewed research reporting data\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.4797507788162%\" valign=\"top\"\u003e\n \u003cp\u003ePeer-reviewed, published studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.881619937694705%\" valign=\"top\"\u003e\n \u003cp\u003eConference abstracts and meeting notes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e*Patient-Reported Experience Measure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSearch\u003c/p\u003e\n\u003cp\u003eThe search was performed on 07 December 2021. The electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO) were chosen because they cover multiple research areas within healthcare. The search was developed in Embase and translated to Medline and Cinahl as recommended.\u003csup\u003e22\u003c/sup\u003e For the phenomenon of interest, we identified the Mesh term \u0026ldquo;Patient Satisfaction\u0026rdquo;. Although we excluded studies reporting on patient satisfaction rather than patient experience, the terms have been used interchangeably,\u003csup\u003e10\u003c/sup\u003e and patient satisfaction thus seemed necessary to include in our search strategy. As the focus on patient\u0026apos;s experiences of coherent care seemed to have emerged around late 1990 and early 2000,\u003csup\u003e23\u003c/sup\u003e we searched for literature from 2000. The search strategy was developed from the predefined definitions and criteria with guidance from research librarians (\u003cem\u003esee full search strategy in Appendix 1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eSelection of Sources of Evidence\u003c/p\u003e\n\u003cp\u003eCovidence (Veritas Health Innovation, Melbourne, Australia) was used to manage the duplication and screening process.\u003csup\u003e24\u003c/sup\u003e All studies were screened by two independent reviewers, and a total of seven reviewers participated in the screening process. To ensure calibration of the screening process, a consensus meeting was arranged at the beginning of the process as in rapid reviews.\u003csup\u003e25\u003c/sup\u003e During the calibration sessions, in- and exclusion criteria were specified further than the a-priori defined criteria (\u003cem\u003eAppendix 2\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eIn the full-text screening process, we experienced a larger number of articles than expected. In order to focus this review on the a priori defined aims, we decided to; I) report on intervention studies in an independent review, II) exclude mixed-methods studies and original qualitative studies, III) synthesize dimensions found in the included syntheses and reviews rather than report on the original studies. We decided to include syntheses and reviews because reports on qualitative studies were frequent, and relevant themes for patient-experienced quality of healthcare transitions had already been mapped in these meta-syntheses, integrative reviews, or scoping reviews.\u003c/p\u003e\n\u003cp\u003eData Charting Process\u003c/p\u003e\n\u003cp\u003eA priori-defined data extraction templates were used and are available at OSF.\u003csup\u003e26\u003c/sup\u003e The data charting was done by one author (SW). The first 10 data extractions were validated independently by a research assistant (NH). The data charting table and process were adapted following the pilot extraction. The final data extraction tables are available in Appendix 3 and Appendix 4.\u003c/p\u003e\n\u003cp\u003eCritical Appraisal of Individual Sources of Evidence\u003c/p\u003e\n\u003cp\u003eAlthough the JBI guidelines for scoping reviews do not warrant critical appraisal,\u003csup\u003e27\u003c/sup\u003e comprehensive (i.e. PREMs including at least five items of the 12 subthemes). PREMs were critically appraised according to the COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures\u003csup\u003e14,28,29\u003c/sup\u003e to assess content validity\u003csup\u003e14\u003c/sup\u003e (relevance, comprehensiveness, and comprehensibility) from patients\u0026rsquo; perspectives. The critical assessment was done independently by two reviewers (SW, LM), and conflicts were discussed until a consensus was reached. When PREMs were mentioned in included publications but not available in the publication, references were followed to the original publications on that PREM.\u003c/p\u003e\n\u003cp\u003eSynthesis of Results\u003c/p\u003e\n\u003cp\u003eWe synthesized the data by; I) Summarizing themes identified in the qualitative syntheses and identifying relevant domains (\u003cem\u003eAppendix 3 and Figure 3\u003c/em\u003e); II) Identifying PREMs, assessing the PREMs phenomenon of interest, and categorizing and listing the items of the relevant PREMs to assess comprehensiveness (\u003cem\u003eAppendix 4, Appendix 5 and Table 2\u003c/em\u003e); III) Assessing the content validity of the most comprehensive PREMs (items related to five or more themes) (\u003cem\u003eTable 2\u003c/em\u003e). The process of synthesizing data is also described in figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1 \u0026ndash; Data Synthesis Process\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe search identified 16,134 records (\u003cem\u003eFigure 2\u003c/em\u003e), and 172 reports were included after the screening and selection process (\u003cem\u003eFigure 2\u003c/em\u003e). In addition to the regular selection process, first author SW divided the reports according to objectives 1 (24 reports) and 2 (148 reports, 35 reports excluded during data extraction, leaving 113 reports for inclusion). This was done because the scientific methods for reports to answer objective 1 needed to be qualitative, and the methods relevant for answering objective 2 needed to be quantitative observational, development, or validation reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2 \u0026ndash; PRISMA Flowchart\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelevant Domains (Results for Objective 1)\u003c/p\u003e\n\u003cp\u003eFor objective one, we included 24 reports (\u003cem\u003eAppendix 6\u003c/em\u003e),\u003csup\u003e30\u0026ndash;53\u003c/sup\u003e which included: 10 (42%) systematic reviews,\u003csup\u003e34,36,37,40,43,44,46,47,49,51\u003c/sup\u003e six (25%) scoping reviews,\u003csup\u003e32,38,41,48,50,53\u003c/sup\u003e Four (17%) meta syntheses,\u003csup\u003e30,39,52\u003c/sup\u003e three (13%) integrated reviews,\u003csup\u003e33,35,42\u003c/sup\u003e one (4%) narrative review,\u003csup\u003e54\u003c/sup\u003e and one (4%) qualitative review\u003csup\u003e45\u003c/sup\u003e that provided information on relevant domains and/or themes for assessing patients\u0026acute; experiences with care across healthcare settings. The number of identified themes ranged from two\u003csup\u003e32\u003c/sup\u003e to 13,\u003csup\u003e50\u003c/sup\u003e with most articles reporting three themes.\u003csup\u003e34,39,52,53\u003c/sup\u003e When summarizing and describing themes from the included reports, we found that the themes could be organized in two distinct domains; I) A system/organizational domain; II) A human-relational domaine. Each of these domains encompassed six themes; thus, we identified 12 relevant themes as illustrated in Figure 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3 \u0026ndash; Domains, Themes, and Items Relevant for Assessing Patients\u0026rsquo; Experiences of Pathways Across Healthcare Settings.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExisting Patient-Reported Experience Measures (Results for Objective 2)\u003c/p\u003e\n\u003cp\u003eFor objective two, we included 113 (\u003cem\u003eAppendix 6\u003c/em\u003e)\u003csup\u003e6\u0026ndash;13,55\u0026ndash;159\u003c/sup\u003e reports that described 109 unique PREMs (\u003cem\u003eAppendix 4\u003c/em\u003e). However, 80 (73%) PREMs were excluded during data extraction as they referred to other aspects of care quality than transitions between healthcare settings or otherwise deviated from our specified phenomenon (\u003cem\u003eAppendix 5\u003c/em\u003e). The Consumer Assessment of Healthcare Providers and Systems (CAHPS)\u003csup\u003e160\u0026ndash;163\u003c/sup\u003e questionnaires were most frequently referred to,\u003csup\u003e6,7,9,11,56,61,63,66\u003c/sup\u003e but we did not find the items relevant according to the construct definition in objective 1. The two relevant PREMs that were most frequently referred to were Nijmegen Continuity Questionnaire\u003csup\u003e8,12,72,77,105,119,151,152\u003c/sup\u003e and Patient Assessment of Chronic Illness Care (PACIC).\u003csup\u003e6,11,12,78,80,85,109,112,164\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn the data extraction process, we identified different ways of formulating items. Some items were worded from a medical system perspective on quality i.e. \u0026ldquo;My physical pain was controlled as well as possible\u0026rdquo;,\u003csup\u003e165\u003c/sup\u003e whereas others were articulated from a patient-centred perspective i.e. \u0026ldquo;My treatment fits my needs\u0026rdquo;.\u003csup\u003e124\u003c/sup\u003e Yet, other items were specific to a certain contextual system infrastructure i.e. \u0026ldquo;The specialist makes out the first prescription for the treatment he/she prescribes me\u0026rdquo;,\u003csup\u003e95\u003c/sup\u003e or they were disease-specific.\u003csup\u003e114\u003c/sup\u003e However, we did identify PREMs with a more generic wording such as, \u0026ldquo;Were there times when you had to repeat information that should have been in your care records?\u0026rdquo;.\u003csup\u003e166\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAdequate reflection of patients\u0026rsquo; experience (results for objective 3)\u003c/p\u003e\n\u003cp\u003eWe extracted 29 PREMs that pertained to patient-experience of quality of transitions in healthcare settings. To assess the relevance and comprehensiveness of the identified PREMs, the items of each PREM were plotted according to the 12 subthemes identified for objective 1 (\u003cem\u003etable 2\u003c/em\u003e). Twenty-one PREMs had items related to at least five of the 12 subthemes (\u003cem\u003etable 2\u003c/em\u003e). To focus our review on the most comprehensive PREMs, we critically appraised the selected 21 PREMs. The Alberta Continuity of Services Scale \u0026ndash; Mental Health (ACSS-MH),\u003csup\u003e124\u003c/sup\u003e the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ),\u003csup\u003e148\u003c/sup\u003e and the Patient Experience of Integrated Care Scale (PEICS)\u003csup\u003e123\u003c/sup\u003e had adequate content validity, however, they were disease-specific and/or did not have items in all themes identified in objective 1 (\u003cem\u003etable 2\u003c/em\u003e). The remaining 16 PREMs had doubtful or inadequate content validity.\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026ndash; Comprehensiveness and Content Validity of Existing PREMs for Assessment of Patients\u0026rsquo; Experiences of the Quality of Transitions in Healthcare Settings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall aim of this scoping review was to define the concept of patient-experienced quality in healthcare transitions and map existing content valid PREMs relevant for measuring this concept. We found the construct of patient-reported experience of transitions in healthcare to consist of two domains \u0026ndash; system/organization and human-relation. However, in summarizing the 24 qualitative reports for this review, we found some inconsistency and lack of clarity in the conceptualization and understanding of patient-experienced quality in healthcare transitions. Although some reports identified the construct of patient-experienced quality in healthcare transitions to consist of two main domains (organization and human-relational),\u003csup\u003e8,9,40,47,158\u003c/sup\u003e others disagreed\u003csup\u003e33,50\u003c/sup\u003e and leaned towards the Institute of Medicine\u0026rsquo;s framework for quality with five or more domains.\u003csup\u003e23\u003c/sup\u003e The two-dimensional model is, however, supported by both qualitative conceptualization\u003csup\u003e40,47\u003c/sup\u003e and testing of measurement properties,\u003csup\u003e8,9,158\u003c/sup\u003e whereas the Institiutes of Medicine\u0026rsquo;s framework is not. In addition to inconsistency in domains, there was a general inconsistency in the number and terminology for themes\u003csup\u003e32,50\u003c/sup\u003e and formulation of items concerning patient-centeredness.\u003csup\u003e124,165\u003c/sup\u003e As items in PREMs may be approached by respondents much the same as a dialogue,\u003csup\u003e167\u003c/sup\u003e we believe a person-centred approach to item formulation may provide the best opportunity for patients to assess quality of care appropriately. Several reports suggest further research into the conceptualization and understanding of patient-experience with care transitions.\u003csup\u003e32,36,49,54\u003c/sup\u003e Due to the variations in how the construct is defined, assessing the content validity of current PREMs becomes challenging.\u003csup\u003e14,15\u003c/sup\u003e Therefore, we support the suggestion of further research into the conceptualization of patient-experienced quality in healthcare transitions.\u003c/p\u003e\n\u003cp\u003eWe identified 29 PREMs that reflected at least one relevant aspect of the construct but none that were comprehensive reflections of generic patient populations\u0026rsquo; experiences of transitions in healthcare settings. This finding aligns with the conclusion of the included reviews of instruments.\u003csup\u003e6\u0026ndash;13,158,159\u003c/sup\u003e It is surprising that we have not identified a content-valid PREM given the large number of reports (113) and unique PREMs (109) included. This may be associated with the lack of clarity in the construct of patient-experienced quality in healthcare transitions. In the future, a generic PREM should be developed to make cross-comparison between studies and healthcare organizations possible. A collective effort to test and use a generice PREM might also support further development and/or understanding of the construct. This, however, would entail a generic approach to item formulation, as seen in P3CEQ,\u003csup\u003e166\u003c/sup\u003e rather than a context-specific approach.\u003csup\u003e95\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIt may be a limitation in our study that our search was imprecise with the inclusion of patient satisfaction in the search terms. However, the sensitivity of our search originates from inclusion of patient satisfaction in the search terms, and we consider the strength of this sensitivity to out way the imprecision by securing a comprehensive review. The comprehensiveness of our search resulted in a large number of records to be reviewed, and thus many reviewers to accommodate for time constraints. We attempted to compensate for a potentially low inter-rater reliability with calibration meetings. Despite of this, the number of reviewers may have been a limitation to the inclusion of all relevant, and only relevant reports. Furthermore, our pragmatic decision of excluding original qualitative studies from this review could have been a limitation to the comprehensiveness of our results. Incorporating the 24 qualitative reports has sufficiently advanced our comprehension of the existing literature to address objective 1. This is corroborated by the absence of new themes identified during data extraction from recent reports. The data extraction performed primarily by one reviewer may have caused some imprecision. However, as we have identified more PREMs than the included reviews of instruments,\u003csup\u003e6\u0026ndash;13,158,159\u003c/sup\u003e this does not seem to be the case. While our scoping review does exhibit certain limitations, the thoroughness of our search and the inclusive methodology employed in comprehending and evaluating patient-experienced quality during healthcare transitions have nonetheless generated novel and significant insights.\u003c/p\u003e\n\u003cp\u003eIn light of our findings, it is plausible\u0026nbsp;that items extracted from the most relevant and comprehensive PREMs, with a focus on generic formulations for infrastructure and disease, would reflect the construct of patient-experienced quality in healthcare transitions adequately. Furthermore, as there is some\u0026nbsp;consensus that quality healthcare transitions occur when organisational structures are flexible and sensitive to patient preferences,\u003csup\u003e34,39\u0026ndash;42,46,53\u003c/sup\u003e it seems advantageous to aply this knowledge in item extraction and/or formulation. As described, the construct seems to be unclear or imprecisely defined. Therefore, a process of extracting and/or formulating items should be undertaken systematically and iteratively with patient involvement and openness to re-evaluating the definition of the construct. A PREM revised by the outlined approach may support valid and reliable evaluation of the effectiveness, safety, and efficiency of healthcare provision.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the literature, we identified several conceptual models that referred to aspects of patients\u0026rsquo; experience with the quality of healthcare transitions. We consider a model with two domains likely to be adequate, however, a more comprehensive analysis and adequate definition of the construct is needed.\u003c/p\u003e\n\u003cp\u003eTwenty-nine PREMs assessing at least one aspect of patients\u0026rsquo; experience of transitions in healthcare were identified. However, none of the PREMs were considered content valid to measure patient-experienced quality in healthcare transitions generically. It is possible that items extracted from the identified questionnaires can be combined for a content-valid PREM. We call for further exploration into the construct of patient experience with healthcare transitions and testing of models to produce a content-valid PREM suitable for generic assessment of patients\u0026rsquo; experiences with the quality of healthcare transitions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe author(s) disclosed receipt of the following financial support for the research, authorship, or publication of this article: This work was supported by the local research fund at N\u0026aelig;stved, Slagelse, and Ringsted hospitals; by a program grant for Exercise First from Region Zealand; and a faculty scholarship from Department of Clinical Research at University of Southern Denmark.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eSW devised the systematic search and review process, contributed substantially to the data extraction and mapping process, and revised the manuscript critically. SGR contributed substantially to the devision of the systematic search and review process, and revised the manuscript critically. SMH contributed substantially to the devision of the search and screening process and revised the manuscript critically. GZ and SRM contributed substantially to the review process and revised the manuscript critically. CBK contributed substantially to the data extraction and mapping process and with critical revision of the manuscript. CS, HHL, and LM made substantial contributions to conceptualisation, the systematic search and review process, the data extraction and mapping process, and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe thank Mette Kring Clausen and Olga Alexandrovna Tchijevitch for reviewing identified literature\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStewart A, MacIntyre G. 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Mahwah, N.J: Lawrence Erlbaum Associates, 2007.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\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-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Healthcare transitions, Patient-Reported Experience Measure, Patient Experience, Quality, Scoping Review","lastPublishedDoi":"10.21203/rs.3.rs-4211885/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4211885/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNo reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients’ experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing PREMs, and evaluate the PREMs’ content validity. The methods was guided by the Joanna Briggs Institutes’ guidance for scoping reviews. The search was performed on 07 December 2021, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 16,134 publications, and 172 studies were included for review. We identified 29 PREMs assessing at least one aspect of adults’ experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.\u003c/p\u003e","manuscriptTitle":"Content Validity of Patient-Reported Measures Evaluating Experiences of the Quality of Transitions in Healthcare Settings - A Scoping Review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 18:22:59","doi":"10.21203/rs.3.rs-4211885/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-10T18:29:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-09T03:04:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-09T03:04:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-04-03T10:10:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"751eaa66-0166-4ea6-933f-dc1199f60f8e","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T17:16:47+00:00","versionOfRecord":{"articleIdentity":"rs-4211885","link":"https://doi.org/10.1186/s12913-024-11298-0","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2024-07-22 16:15:10","publishedOnDateReadable":"July 22nd, 2024"},"versionCreatedAt":"2024-04-12 18:22:59","video":"","vorDoi":"10.1186/s12913-024-11298-0","vorDoiUrl":"https://doi.org/10.1186/s12913-024-11298-0","workflowStages":[]},"version":"v1","identity":"rs-4211885","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4211885","identity":"rs-4211885","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}