title: Development and Validation of the CPO Scale, a New Instrument for Evaluation of Health Care Improvement Efforts.
abstract: OBJECTIVE
  To develop and validate an instrument for guidance and evaluation of quality and safety improvement efforts in health care.
  
  
  BACKGROUND
  The instrument is based on the Plan-Do-Study-Act cycle and the 3 fundamental improvement questions regarding aims, measurement, and change-making.
  
  
  METHODS
  An interdisciplinary team of improvement experts developed the Change Process and Outcome (CPO) scale. After studying the improvement literature, the scale was tested and refined on a sample of 5 projects. The CPO evaluation process and classification system was developed when evaluating 189 of the quality improvement projects of the Norwegian Medical Association by their final reports. The scale was validated by applying statistical testing to the evaluation results.
  
  
  RESULTS
  The final CPO scale consists of 13 process items and 7 outcome items. Interrater reliability ranged from 0.53 to 0.79, and test-retest reliability was 0.82. Factor analyses with Varimax rotation identified 2 significant process domains: Aims/change-making and Measurement/reporting, with Cronbach α values 0.88 and 0.95, respectively. The classification system produced 3 performance levels: successful, promising, and uncertain.
  
  
  CONCLUSIONS
  The CPO scale shows good internal consistency, reliability, and validity for evaluating the success of quality improvement initiatives.
authors.affiliation: Quality Department, Vestre Viken Health Trust, Drammen, Norway (Ms Brandrud); South Eastern Norway Regional Health Authority, Hamar, Norway (Ms Haldorsen); Municipality of Porsgrunn, Norway (Dr Nyen); Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway (Ms Vårdal and Dr Sandvik); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Dr Nelson); and Department of Health and Society, Faculty of Medicine, University of Oslo, Norway (Dr Hjortdahl).
authors.forename: Aleidis Skard
authors.initials: AS
authors.lastname: Brandrud
authors.forename: Gro Sævil Helljesen
authors.initials: GS
authors.lastname: Haldorsen
authors.forename: Bjørnar
authors.initials: B
authors.lastname: Nyen
authors.forename: Mari
authors.initials: M
authors.lastname: Vårdal
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Nelson
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Per
authors.initials: P
authors.lastname: Hjortdahl
mesh_terms: D057189:Checklist; D003695:Delivery of Health Care / Q000592:standards*; D009664:Norway; D009936:Organizational Innovation; D058996:Quality Improvement / Q000458:organization & administration*