title: Field testing, refinement, and psychometric evaluation of a new measure of quality of care for assisted living.
abstract: Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, generalizability theory, and exploratory factor analysis. The 34-item scale has a coherent six-factor structure that conceptually describes the multidimensional concept of care quality in assisted living. The six factors can be logically clustered into process (Homelike and Caring, 21 items) and structure (Access and Choice; Lighting; Plants and Pets; Outdoor Spaces) subscales and for a total quality score. Classical test theory results indicate most subscales and the total quality score from the OIQ-AL have acceptable interrater, test-retest, and strong internal consistency reliabilities. Generalizability theory analyses reveal that dependability of scores from the instrument are strong, particularly by including a second observer who conducts a site visit and independently completes an instrument, or by a single observer conducting two site visits and completing instruments during each visit. Scoring guidelines based on the total sample of observations (N = 358) help guide those who want to use the measure to interpret both subscale and total scores. Content validity was supported by two expert panels of people experienced in the assisted-living field, and a content validity index calculated for the first version of the scale is high (3.43 on a four-point scale). The OIQ-AL gives reliable and valid scores for researchers, and may be useful for consumers, providers, and others interested in measuring quality of care in assisted-living facilities.
authors.affiliation: Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University Hospital, University of Missouri, Columbia, MO 65211, USA. rantzm@missouri.edu
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Rantz
authors.forename: Myra A
authors.initials: MA
authors.lastname: Aud
authors.forename: Mary
authors.initials: M
authors.lastname: Zwygart-Stauffacher
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Petroski
authors.forename: Steven V
authors.initials: SV
authors.lastname: Owen
authors.forename: Richard W
authors.initials: RW
authors.lastname: Madsen
authors.forename: Marcia
authors.initials: M
authors.lastname: Flesner
authors.forename: Vicki
authors.initials: V
authors.lastname: Conn
authors.forename: Meridean
authors.initials: M
authors.lastname: Maas
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D005163:Factor Analysis, Statistical; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007374:Interior Design and Furnishings; D008029:Lighting / Q000592:standards; D008923:Missouri; D015403:Nursing Evaluation Research; D009735:Nursing Homes / Q000592:standards*; D015404:Nursing Methodology Research; D015588:Observer Variation; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000592:standards; D010358:Patient Participation; D011594:Psychometrics; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014922:Wisconsin