title: Development of a survey instrument to measure patient experience of integrated care.
abstract: Healthcare systems are working to move towards more integrated, patient-centered care. This study describes the development and testing of a multidimensional self-report measure of patients' experiences of integrated care.
  
  
  
  Random-digit-dial telephone survey in 2012 of 317 adults aged 40 years or older in the San Francisco region who had used healthcare at least twice in the past 12 months. One-time cross-sectional survey; psychometric evaluation to confirm dimensions and create multi-item scales. Survey data were analyzed using VARCLUS and confirmatory factor analysis and internal consistency reliability testing.
  
  
  
  Scales measuring five domains were confirmed: coordination within and between care teams, navigation (arranging appointments and visits), communication between specialist and primary care doctor, and communication between primary care doctor and specialist. Four of these demonstrated excellent internal consistency reliability. Mean scale scores indicated low levels of integration.
  
  
  
  These scales measuring integrated care capture meaningful domains of patients' experiences of health care. The low levels of care integration reported by patients in the study sample suggest that these types of measures should be considered in ongoing evaluations of health system performance and improvement. Further research should examine whether differences in patient experience of integrated care are associated with differences in the processes and outcomes of care received.
authors.affiliation: Patient Centered Outcomes Research Institute, Washington, DC, USA. kwalker@pcori.org.|, 1828L Street NW, Washington, DC, USA. kwalker@pcori.org.
authors.forename: Kara Odom
authors.initials: KO
authors.lastname: Walker
authors.affiliation: Institute for Health & Aging, Center for Aging in Diverse Communities, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
authors.affiliation: Department of Family and Community Medicine, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Grumbach
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D011594:Psychometrics; D015203:Reproducibility of Results; D012495:San Francisco; D057566:Self Report
keywords: Integrated care; Patient experience; Scale development