title: A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire.
abstract: BACKGROUND
  The CCAENA questionnaire was developed to assess care continuity across levels from the patients' perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire.
  
  
  METHODS
  Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three health care areas of the Catalan health care system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity) and the item-rest correlations and Cronbach's alpha were calculated (internal consistency). Spearman correlation coefficients were calculated (multidimensionality) and the ability to discriminate between groups was tested.
  
  
  RESULTS
  The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbach's alpha indicated good internal consistency (0.97, 0.93, 0.80) and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to health care area, age and educational level.
  
  
  CONCLUSIONS
  The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients' perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for health care improvement.
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit. Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: Marta-Beatriz
authors.initials: MB
authors.lastname: Aller
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Garcia-Subirats
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà, PalamÓs, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Coderch
authors.affiliation: Health Policy and Health Services Research Group; Strategic Planning Division, SAGESSA Group, Reus, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Colomés
authors.affiliation: Health Policy and Health Services Research Group; Division of Management, Planning and Organizational Development, Badalona Healthcare Services (BSA), Badalona, Spain.
authors.forename: Josep Ramon
authors.initials: JR
authors.lastname: Llopart
authors.affiliation: Teaching Department, Catalan Health Institute (ICS), Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Ferran
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix, PalamÓs, Spain.
authors.forename: Inma
authors.initials: I
authors.lastname: Sánchez-Pérez
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Vázquez
keywords: continuity of patient care; delivery of health care; outcome and process assessment (health care); questionnaires