title: Development of the Primary Care Quality-Homeless (PCQ-H) instrument: a practical survey of homeless patients' experiences in primary care.
abstract: BACKGROUND
  Homeless patients face unique challenges in obtaining primary care responsive to their needs and context. Patient experience questionnaires could permit assessment of patient-centered medical homes for this population, but standard instruments may not reflect homeless patients' priorities and concerns.
  
  
  OBJECTIVE
  This report describes (a) the content and psychometric properties of a new primary care questionnaire for homeless patients; and (b) the methods utilized in its development.
  
  
  METHODS
  Starting with quality-related constructs from the Institute of Medicine, we identified relevant themes by interviewing homeless patients and experts in their care. A multidisciplinary team drafted a preliminary set of 78 items. This was administered to homeless-experienced clients (n=563) across 3 VA facilities and 1 non-VA Health Care for the Homeless Program. Using Item Response Theory, we examined Test Information Function (TIF) curves to eliminate less informative items and devise plausibly distinct subscales.
  
  
  RESULTS
  The resulting 33-item instrument (Primary Care Quality-Homeless) has 4 subscales: Patient-Clinician Relationship (15 items), Cooperation among Clinicians (3 items), Access/Coordination (11 items), and Homeless-specific Needs (4 items). Evidence for divergent and convergent validity is provided. TIF graphs showed adequate informational value to permit inferences about groups for 3 subscales (Relationship, Cooperation, and Access/Coordination). The 3-item Cooperation subscale had lower informational value (TIF<5) but had good internal consistency (α=0.75) and patients frequently reported problems in this aspect of care.
  
  
  CONCLUSIONS
  Systematic application of qualitative and quantitative methods supported the development of a brief patient-reported questionnaire focused on the primary care of homeless patients and offers guidance for future population-specific instrument development.
authors.affiliation: *Birmingham VA Medical Center, School of Medicine †Department of Social Work, University of Alabama at Birmingham, Birmingham, AL ‡Alpert School of Medicine at Brown University, Providence, RI §University of Alabama at Birmingham School of Health Related Professions, Birmingham, AL ∥George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO ¶VA Pittsburgh Health Care System, Center for Health Equity Research and Promotion, University of Pittsburgh School of Medicine, Pittsburgh, PA #Birmingham VA Medical Center, Birmingham, AL **Boston University School of Medicine, Boston Health Care for the Homeless Program, Boston, MA ††Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), University of Alabama at Birmingham, Birmingham, AL ‡‡VA Desert Pacific Mental Illness Research Education and Clinic Center (MIRECC) §§Department of Psychiatry, Greater Los Angeles VA Healthcare Center, University of California Los Angeles, Los Angeles, CA ∥∥Tuscaloosa VA Medical Center, Tuscaloosa, AL ¶¶Johns Hopkins University, Center on Aging and Health, Baltimore ##University of Maryland School of Public Health, College Park, MD.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
authors.forename: David E
authors.initials: DE
authors.lastname: Pollio
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Steward
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Stringfellow
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Johnson
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Kim
authors.forename: Shanette G
authors.initials: SG
authors.lastname: Daigle
authors.forename: Erika L
authors.initials: EL
authors.lastname: Austin
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Young
authors.forename: Joya G
authors.initials: JG
authors.lastname: Chrystal
authors.forename: Lori L
authors.initials: LL
authors.lastname: Davis
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holt
mesh_terms: D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D011594:Psychometrics; D011787:Quality of Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires