Patient Related Outcome Measures (Jun 2018)
The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England
Abstract
Laura Kelly,1 Steve Sizmur,2 Susanne Käsbauer,2 Jenny King,2 Robyn Cooper,2 Crispin Jenkinson,1 Chris Graham2 1Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 2Research Division, Picker Institute Europe, Oxford, UK Purpose: The Relational Aspects of Care Questionnaire (RAC-Q) is an electronic instrument which has been developed to assess staff’s interactions with patients when delivering relational care to inpatients and those accessing accident and emergency (A&E) services. The aim of this study was to reduce the number of questionnaire items and explore scoring methods for “not applicable” response options.Patients and methods: Participants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015–2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of 10 months. Items were subjected to exploratory factor analysis to confirm unidimensionality, and the number of items was reduced using a range of a priori psychometric criteria. Two alternative approaches to scoring were undertaken, one treated “not applicable” responses as missing data, while the second adopted a problem score approach where “not applicable” was considered “no problem with care.”Results: Two short-form RAC-Qs with alternative scoring options were identified. The first (the RAC-Q-12) contained 12 items, while the second scoring option (the RAC-Q-14) contained 14 items. Scores from both short forms correlated highly with the full 20-item parent form score (RAC-Q-12, r=0.93 and RAC-Q-14, r=0.92), displayed high internal consistency (Cronbach’s α: RAC-Q-12=0.92 and RAC-Q-14=0.89) and had high levels of agreement (intraclass correlation coefficient [ICC]=0.97 for both scales).Conclusion: The RAC-Q is designed to offer near-real-time feedback on staff’s interactions with patients when delivering relational care. The new short-form RAC-Qs and their respective method of scoring are reflective of scores derived using the full 20-item parent form. The new short-form RAC-Qs may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Using either the RAC-Q-12 or the RAC-Q-14 offers a method to reduce missing data and response fatigue. Keywords: real-time feedback, patient experience, surveys, hospital care, emergency care
