title: A measurement instrument for spread of quality improvement in healthcare.
abstract: OBJECTIVE
  The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread and sustainability of changed work practices were also explored to assess convergent validity.
  
  
  METHODS
  We developed and tested a measurement instrument for spread in a follow-up study. The instrument consisted of 18-items with four subscales.
  
  
  METHODS
  The sample consisted of former improvement teams in a quality improvement program for long-term care (nteams = 73, nrespondents = 127). Data were collected in a questionnaire about 1 year post-pilot site improvement implementation.
  
  
  METHODS
  Quality improvements in long-term care practices.
  
  
  METHODS
  Four variables were construed: (i) actions for spread of work practices, (ii) actions for spread of results, (iii) effectiveness of spread of work practices and (iv) effectiveness of spread of results.
  
  
  RESULTS
  Psychometric analysis yielded positive results on the item level. The intended four-factor model yielded satisfactory fit. The internal consistency of each scale was fine (Cronbach's α 0.70-0.93). Bivariate correlations revealed that the spread variables were strongly related but distinct, and positively related to the sustainability variables.
  
  
  CONCLUSIONS
  The psychometric properties are in line with methodological standards. Convergent validity was confirmed with sustainability. The measurement instrument offers a good starting point for the analysis of spread.
authors: Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. sueslaghuis@gmail.com
authors: S S
authors: SS
authors: Slaghuis
authors: M M H
authors: MM
authors: Strating
authors: R A
authors: RA
authors: Bal
authors: A P
authors: AP
authors: Nieboer
mesh_terms: D004059:Diffusion of Innovation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D009426:Netherlands; D011594:Psychometrics; D058996:Quality Improvement; D011795:Surveys and Questionnaires