Table 6 'Transition of Care - Patient's Understanding of the Purpose of their Medication'

PSI 6: Transition of Care – Patient’s Understanding of their Medication
Origin: PSI by SimPatIE
Dimension Description
Description of Specific
Aspects of Patient Safety
Communication and transfer of information between healthcare
settings and between professionals and patients are essential
aspects of patient safety. Especially care transition processes are
known to be vulnerable regarding patient safety. Understanding
the purpose of the medication can impact compliance. Adherence
to medications is important as lack of compliance can have fatal
consequences for the patient.
Aim of the PSI This PSI aims at highlighting the quality of staff patient
communication regarding patients understanding of the purpose of
their medication when leaving hospital.
Level of Determination of
Patient Safety
Safety is assessed at the aggregate patient level.
Source(s) This PSI is derived from the “Care Transitions Measure” question
3. Please see www.caretransitions.org
Dr. Coleman and colleagues have designed a measure to assess
the quality of care transitions: the Care Transitions Measure
(CTM ©). The CTM exists in two forms a 15-item unidimensional
version and a three-item version (CTM-3), which is a
subset of the 15 items version. The primary objective of the
development of CTM was a measure that is both substantively and
methodologically consistent with the concept of patientcenteredness,
and useful for the purpose of performance
measurement and subsequent public reporting. CTM assesses
health care professionals accomplished essential care processes
(14).
Extent of Clinically Testing CTM is used in 15 different countries.
Specific CTM items were developed; pilot tested, and refined
using focus groups. By standard qualitative analytic techniques
applied to the written interview transcripts, four key domains were
found for the CTM. The domains were: 1) information transfer; 2)
patient and caregiver preparation; 3) self-management support;
and 4) empowerment to assert preferences. Psychometric testing
of the CTM included content and construct validity, intra-item
variation, and floor/ceiling properties. High internal consistency
and reliability were found. Also applicability for assessment
across multiple sites of care: hospital to home, hospital to skilled
nursing facility, skilled nursing facility to home was good. CTM
demonstrated power to discriminate between: 1) patients
discharged from hospital that did/did not experience a subsequent
emergency visit or readmission for their index condition, and 2)
SImPatIE WP4 – Catalogue of Patients Safety Indicators
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health care facilities with differing levels of commitment to care
coordination. The researchers concluded: “CTM may serve to fill
an important gap in health system performance evaluation by
measuring the quality of care delivered across settings” (14).
The developer of TCM-3 have studied the differential item
function by gender, self rated health, age, educational level and
ethnicity. It was found that these variables do not bias the
responses on TCM-3. No risk adjustment was found necessary
(15-17)
Specifications are given for the use of CTM-3 in five domains: 1)
Survey Instrument, 2) Sampling, 3) Survey administration 4)
Scoring and patient mix adjustment and 5) Reporting data (15).
Dr. Coleman and his colleagues also developed a 4-week Care
Transition Intervention program, which was tested in a
randomised controlled trial. Patients with complex care needs
received either treatment as usual or the CTM-intervention:
specific tools, support by a “Transition Coach,” and selfmanagement
skills. Patients in the CTM-program were
significantly less likely to be readmitted and they were more
likely to achieve self-identified personal goals around symptom
management and functional recovery. Findings were sustained for
as long as six months after the program ended (18).
Evidence of Clinically use of
Standards
No evidence of clinically use of standards was found.
PSI category Institution-Wide PSI.
Data definitions Patient’s agreement that they understand the purpose for taking
their medicine measured on a 5-point Likert scale per 100
discharges.
Numerator Description Number of patients agreeing that they understand the purpose of
taking their medication rated as “Agree” or “Strongly agree”
measured on a 5-point Likert scale ranging from “Strongly
Disagree”, “Disagree”, “Don’t know/Don’t remember/Not
applicable” to “Agree” and “Strongly Agree”.
Denominator Description Number of discharges from acute care hospitals.
Exclude:
- Psychiatric patients/ Patients with cognitive disorders
- Paediatric patients under age 18 years
- Patients who die in hospital
- Patients who did not stay at least one night in hospital
- Other patients as required by law or regulation in the state
in which the hospital operates
Data Source The Care Transitions Measure (CTM-3) Question 3.
Identifying the institutional
context
The impact of high quality communication and information makes
this PSI important in safety improvement policies.
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Care Setting The PSI applies institution-wide.
Professionals Responsible for
Health Care
All authorised health care workers.
Lowest Level of Health Care
Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by Vulnerable
Populations
No stratification.
Standard of Comparison Yearly. Please see (15).
Scoring Scores are obtained and scored on a 5-point Likert scale ranging
from “Strongly Disagree”, “Disagree”, “Don’t know/Don’t
remember/Not applicable” to “Agree” and “Strongly Agree”.
Scores of “Agree” and “Strongly Agree”. Scores are cumulated
and frequencies calculated. Specifications are given for the use of
CTM-3 in five domains: 1) Survey Instrument, 2) Sampling, 3)
Survey administration 4) Scoring and patient mix adjustment and
5) Reporting data (15).