title: The use of cognitive interviews to revise the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM).
abstract: OBJECTIVE
  The "Quality of Trauma Care Patient-Reported Experience Measure" is the first measure of patient experiences with overall injury care. The objective of this study was to use cognitive interviews to inform revision of the measure into a parsimonious set of items that function as intended, in preparation for multicenter testing.
  
  
  METHODS
  Concurrent and retrospective cognitive interviews with injured patients (n = 17) and family members (n = 13) using semi-structured interview guides. Responses were analyzed using thematic analysis.
  
  
  RESULTS
  Six broad themes were identified and guided revisions: (1) participants did not have the information to answer items (n = 9); (2) items were ambiguous or were inconsistently interpreted (n = 13); (3) items did not measure the intended constructs (n = 6); (4) items included assumptions about healthcare processes (n = 4); (5) items measured non-priority aspects of injury care (n = 8); and (6) items were redundant (n = 5). Two issues resulted in key conceptual and content changes: participants' difficulty to evaluate pre-hospital, emergency department, and intensive care unit services due to recall issues and the challenge to evaluate the effectiveness and equity of care. In total, 39 items were deleted, 28 new items developed, and the final instrument included 63 items.
  
  
  CONCLUSIONS
  Our results informed changes to item content, format, and response options. This study highlights key issues to consider when incorporating patient/family perspectives into quality measurement, most notably, that few participants can assess the quality of care in the pre-hospital and emergency department phases of care and that novel methods are needed to evaluate the effectiveness and equity of care.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, 2nd Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK, niklas.bobrovitz@gtc.ox.ac.uk.
authors.forename: Niklas
authors.initials: N
authors.lastname: Bobrovitz
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Santana
authors.forename: Theresa
authors.initials: T
authors.lastname: Kline
authors.forename: John
authors.initials: J
authors.lastname: Kortbeek
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D000328:Adult; D003071:Cognition / Q000502:physiology*; D005190:Family; D005260:Female; D006761:Hospitals; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000628:therapy*