Development and psychometric properties of surveys to assess provider perspectives on the barriers and facilitators of effective care transitions

Maurice C. Johnson, Helen Liu, Joann Sorra, Jane Brock, Brianna Gass, Jing Li, Jessica Miller Clouser, Karen Hirschman, Deborah Carpenter, Huong Q. Nguyen, Mark V. Williams

Research output: Contribution to journalArticlepeer-review


Background: The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services. Methods: We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. Results: Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). Conclusions: We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.

Original languageEnglish
Article number478
JournalBMC Health Services Research
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (TC-1403-14049). The statements in this manuscript are solely the authors’ responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

Funding Information:
The present study is part of a comprehensive and collaborative team effort. The authors would like to acknowledge the significant contributions from the following individuals in the conduct of this study. University of Kentucky: Chris Cook, MS, Megan McIntosh, and Dan Cleland, MS, for their assistance with project coordination and administration. Kaiser Permanente: Heather Watson, MBA, Sandra Koyama, MD, Dan Huynh, MD, Maria Taitano, MD, Ernest Shen, PhD, Angel Alem, MPH, Thearis Osuji, MPH, and Janet Shim, MS for their assistance in project conceptualization and coordination. Boston Medical Center: Suzanne Mitchell, MD, and Jessica Howard Martin, MA, MPH, for their project conceptualization assistance. Telligen: Christine LaRocca, MD, and Lacy McFall for their assistance in project conceptualization. Westat: John Rauch, Katarzyna Zebrak, PhD, Theresa Famolaro, MBA, MS for project conceptualization, coordination, and the design and conduct of patient and provider surveys. University of Pennsylvania: Mary Naylor, PhD, RN; MSW; Mark Pauly, PhD; and Kathleen McCauley, PhD, RN for their assistance in project conceptualization, coordination, and feedback on the manuscript.

Publisher Copyright:
© 2021, The Author(s).


  • Barriers
  • Care transitions
  • Composite measures
  • Facilitators
  • Health care surveys
  • Provider experience
  • Psychometrics
  • Transitional care

ASJC Scopus subject areas

  • Health Policy


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