Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM)

Madeleine J Bryant; Rachel J Black; Susan Lester; Vibhasha Chand; Claire Barrett; Rachelle Buchbinder; Marissa Lassere; Lyn March; Catherine L Hill

doi:10.1093/rap/rkae099

Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM)

Rheumatol Adv Pract. 2024 Aug 17;8(4):rkae099. doi: 10.1093/rap/rkae099. eCollection 2024.

Authors

Madeleine J Bryant^{1

2

3}, Rachel J Black^{1

2

3}, Susan Lester^{1

2}, Vibhasha Chand⁴, Claire Barrett^{5

6}, Rachelle Buchbinder⁴, Marissa Lassere^{7

8}, Lyn March^{9

10}, Catherine L Hill^{1

2

3}

Affiliations

¹ School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
² Rheumatology Unit, Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
³ Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁴ Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.
⁶ Department of Rheumatology, Redcliffe Hospital, Redcliffe, Queensland, Australia.
⁷ Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁸ Department of Rheumatology, St George Hospital, Kogarah, New South Wales, Australia.
⁹ Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
¹⁰ Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Objectives: To evaluate the reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis-RA-Patient-Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort.

Methods: Individual patient interviews were performed to check the language and completion time of the CQRA-RA-PREM before modification. Australian Rheumatology Association Database (ARAD) participants completed the CQRA-PREM-Australian version (CQRA-PREM-AU) (22 items, 5 domains), disease activity measure (RAPID-3, BASDAI) and Assessment of Quality of Life (AQOL-6D) index. Exploratory factor analysis (EFA) assessed item correlation. Cronbach's α assessed internal consistency.

Results: Individual patient interviews (n = 8, 62% male, mean age 50 years, mean disease duration 4.5 years) informed CQRA-RA-PREM modification. The ARAD survey response rate was 707/1124 (63%); 459 (65%) RA, 134 (19%) PsA, 114 (16%) AS; 67% female, mean age 62 years, mean disease duration 22 years. The median instrument completion time was 299 s (interquartile range 284-414). Scoring of responses allowed an averaged overall score. EFA extracted five factors: all items loading similarly onto factor 1, indicating validity of the overall score. The CQRA-PREM-AU score correlated with the AQOL-6D score (ρ = 0.23, P < 0.01); partial correlation with disease activity was not significant (ρ = 0.03, P = 0.45), indicating divergent validity. Reliability was comparable across disease subgroups (Cronbach's α >0.94). The mean overall score did not differ by disease subgroup [4.1 (s.d. 0.6, P = 0.73) and there was no floor/ceiling effect.

Conclusion: CQRA-PREM-AU is a valid and reliable instrument to measure self-reported care experience in Australian rheumatology patients and may be interpreted as an average overall numerical score.

Keywords: care quality; healthcare innovation; outcome measures; patient experience.