Measurement of continuity of care in cardiac patients: reliability and validity of an in-person questionnaire

Abstract

Background: Breaks in continuity of care occur during the care of patients with cardiac conditions, such as congestive heart failure (CHF) and atrial fibrillation (AF), during their hospitalization, the discharge process or follow-up care. Recently, to measure continuity of care for such patients, a comprehensive questionnaire was developed to reflect the cardiac patient's perspective on multifaceted aspects of continuity of care.

Objective: To examine the psychometric properties of an in-person interview questionnaire for the measurement of continuity of care in patients recently hospitalized with CHF or AF.

Methods: The Heart Continuity of Care Questionnaire (HCCQ) was administered to 350 cardiac patients (176 with CHF and 174 with AF) at least six months after discharge from hospitals in two urban centres. The questionnaire was assessed by item and principal components analysis. Factors derived from principal components analysis were assessed for internal consistency and construct validity against variables of comorbidity, health status and symptom severity.

Results: A principal components analysis produced three subscales. These subscales were internally consistent, and demonstrated construct validity through expected correlations with other variables and theoretical constructs.

Conclusion: The present study supports the reliability and validity of the HCCQ for measuring continuity of care. The HCCQ subscales correspond to the theoretical components of continuity of care that have been proposed, namely relational, informational and management continuity. The HCCQ subscales may be of value for identifying problems in continuity of care and for evaluating interventions aimed at improving continuity of care for cardiac patients after hospital discharge.