Patient Assessment of Transitions in Healthcare settings: PATH

Introduction
Transitions between healthcare settings, such as hospital discharges to primary care, are critical periods that can significantly impact patient outcomes. Patient-reported experience measures (PREMs) are essential tools for assessing and enhancing the quality of these transitions. However, existing PREMs lack sufficient validity and reliability, limiting their effectiveness in capturing comprehensive patient experiences.

Aim
The aim of this PhD thesis was to develop a robust patient-reported experience measure, "Patient Assessment of Transitions in Healthcare settings (PATH)”, designed to validly and reliably evaluate patient experiences during transitions across various healthcare settings.

Methods
An iterative research design was employed, encompassing both qualitative and quantitative approaches. Initially, a scoping review was conducted to identify key domains relevant to patient experiences during healthcare transitions and existing PREMs. Subsequently a qualitative interview study was undertaken to gain deeper insights into Danish patients’ experiences of quality in pathways which include transitions across healthcare settings. Based on these findings, the PATH questionnaire was developed. The questionnaire underwent rigorous assessment, including assessments of content validity, construct validity, and reliability, following the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Data were collected from a diverse sample of adult patients navigating transitions between healthcare settings. Exploratory factor analysis, Rasch analysis and test-retest reliability analysis, were performed to evaluate the psychometric properties of PATH.

Results
The scoping review and qualitative study identified several critical themes influencing patient experiences during transitions, which were described in the overall domains system organization and flexibility, and kind and merciful healthcare professionals. The PATH questionnaire was constructed to encompass these domains comprehensively. Assessment of psychometric properties established that PATH has content validity, ensuring that it measures the intended constructs of patient-experienced quality in healthcare transitions. Construct validity was demonstrated through exploratory factor analysis and Rasch analysis, revealing a structure aligned with the identified domains. Reliability assessments indicated high internal consistency and good test-retest reliability. Additionally, PATH was found to have the ability to discriminate between poor, moderate, and good patient experiences of quality in pathways including transitions across healthcare settings, making it a reliable tool for both clinical assessments and research purposes.

Conclusion
The development and assessment of the PATH questionnaire provide a valuable instrument for measuring patient-reported experiences during healthcare transitions. PATH's robust psychometric properties make it suitable for widespread use in evaluating and improving the quality of transitional care. Implementing PATH in evaluation of healthcare services can facilitate the identification of areas for improvement, ultimately enhancing continuity, coordination, and patient-centeredness in care transitions. This may contribute to better health outcomes, increased patient satisfaction, and more efficient healthcare delivery systems.