title: Development and testing of a measure designed to assess the quality of care transitions.
abstract: BACKGROUND
  To improve the quality of care delivered to older persons receiving care across multiple settings, interventions are needed. However, the absence of a patient-centred measure specifically designed to assess this care has constrained innovation.
  
  
  OBJECTIVE
  To develop a rigorously designed and tested measure, the Care Transition Measure (CTM).
  
  
  METHODS
  A large, integrated managed care organisation in Colorado with approximately 55,000 members over the age of 65 years.
  
  
  METHODS
  Patients 65 years and older who were recently discharged from hospital and received subsequent skilled nursing care in a facility or in the home.
  
  
  METHODS
  Six focus groups of older persons and their caregivers (n=49) were established. Standard qualitative analytic techniques were applied to written transcripts and four key domains were identified: (1) information transfer; (2) patient and caregiver preparation; (3) self-management support; and (4) empowerment to assert preferences. Specific CTM items were developed, pilot tested, and refined. Psychometric testing, conducted in a different population but selected using the same entry criteria (n=60), included content and construct validity, intra-item variation, and floor/ceiling properties.
  
  
  RESULTS
  Older patients and clinicians found the measure to be highly relevant and comprehensive (i.e. content validity). Construct validity was assessed by comparing items from the CTM to selected items from a measure developed by Hendriks and colleagues (Medical Care 2001; 39(3): 270-283). Inter-item Spearman correlations ranged 0.388-0.594. No significant floor or ceiling effects were detected.
  
  
  CONCLUSIONS
  The CTM was developed with substantial input from older patients and their caregivers. Psychometric testing suggested that the measure was valid. The CTM may serve to fill an important gap in health system performance evaluation by measuring the quality of care delivered across settings.
authors.affiliation: Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado, USA. Eric.Coleman@uchsc.edu
authors.forename: Eric A
authors.initials: EA
authors.lastname: Coleman
authors.forename: Jodi D
authors.initials: JD
authors.lastname: Smith
authors.forename: Janet C
authors.initials: JC
authors.lastname: Frank
authors.forename: Theresa B
authors.initials: TB
authors.lastname: Eilertsen
authors.forename: Jill N
authors.initials: JN
authors.lastname: Thiare
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kramer