Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters

Abstract

Importance: As video-based care expands in many clinical settings, assessing patient experiences with this care modality will help optimize health care quality, safety, and communication.

Objective: To develop and assess the psychometric properties of the video visit user experience (VVUE) measure, a patient-reported measure of experiences with video-based technology.

Design, setting, and participants: In this survey study, veterans completed a web-based, mail, or telephone survey about their use of Veterans Healthcare Administration (VHA) virtual care between September 2021 and January 2022. The survey was completed by patients who reported having a VHA video visit on their own device or a VHA-issued device and linked to VHA utilization data for the 6 months following the survey. Data analysis was performed from March 2022 to February 2023.

Main outcomes and measures: The survey included 19 items about experiences with video visits that were rated using a 4-point Likert-type scale (strongly disagree to strongly agree). First, an exploratory factor analysis was conducted to determine the factor structure and parsimonious set of items, using the McDonald Omega test to assess internal consistency reliability. Then, a confirmatory factor analysis was conducted to test structural validity, and bivariate correlations between VVUE and VHA health care engagement were calculated to test concurrent validity. Finally, predictive validity was assessed using logistic regression to determine whether VVUE was associated with future VHA video visit use.

Results: Among 1887 respondents included in the analyses, 83.2% (95% CI, 81.5%-84.8%) were male, 41.0% (95% CI, 38.8%-43.1%) were aged 65 years or older, and the majority had multiple chronic medical and mental health conditions. The exploratory factor analysis identified a 10-item single-factor VVUE measure (including questions about satisfaction, user-centeredness, technical quality, usefulness, and appropriateness), explaining 96% of the total variance, with acceptable internal consistency reliability (ω = 0.95). The confirmatory factor analysis results confirmed a single-factor solution (standardized root mean squared residual = 0.04). VVUE was positively associated with VHA health care engagement (ρ = 0.47; P < .001). Predictive validity models demonstrated that higher VVUE measure scores were associated with future use of video visits, where each 1-point increase on VVUE was associated with greater likelihood of having a video visit in subsequent 6 months (adjusted odds ratio, 1.04; 95% CI, 1.02-1.06).

Conclusions and relevance: The findings of this study of veterans using video visits suggest that a brief measure is valid to capture veterans' experiences receiving VHA virtual care.

Figure 1.. Survey Sampling and Response Flowchart

Flowchart shows the sampling strategy that was used for the survey, including stratified sampling for 3 distinct cohorts: recent recipients of Veterans Affairs (VA)–issued tablets, non–tablet recipients who had a video visit documented in their health record, and non–tablet recipients who did not have a video visit documented in their health record. The analytic cohort is limited to survey respondents who reported having a video visit (self-report VA Video Connect [VVC] use) and completed the video visit user experience (VVUE) questions.

Figure 2.. Adjusted Estimated Probabilities of VA Video Connect (VVC) Use Within 6 Months by Video Visit User Experience (VVUE) Score

Graph shows the association of an individual’s VVUE score with the estimated probability of a video visit within 6 months, adjusted for age, race, marital status, gender, geographic area, number of physical health conditions, and any mental health conditions.