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      The Measure of the Family Caregivers’ Experience

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          Abstract

          Objective: Design and validate a measure of the experience of family caregivers with the integrated care that receive the persons they care for. Methods: The new instrument for measuring the experience of caregivers is based on the Instrument to Evaluate the EXperience of PAtients with Chronic Diseases (acronym in Spanish: IEXPAC) scale instrument. With the qualitative technique of the discussion group, nine professionals and eight caregivers assessed the face validity of the instrument and they advised on issues to explore and the measuring scale to use. The instrument’s items were analyzed individually, as well as its consistency, reliability, and construct and empirical validity. Results: 235 caregivers responded, of which 186 (79%) were women. The average age of the persons under their care was 83.9 years (SD 9.7). The scale’s score when eliminating its items one by one ranged between 38.6 and 41.1. The factorial saturations of the items ranged between 0.53 and 0.82. Cronbach’s alpha (12 elements) was 0.88 and the Kuder-Richardson coefficient was 0.91. The factorial solution explained 64.3% of the total variance and allowed isolating two factors (with 11 items with saturations greater than 0.65): care for the patient, and care for the caregiver. The internal consistency of both factors was greater than 0.80. The scale’s score was 41.1 (SD 9.7). Conclusions: The Caregivers Experience Instrument combines acceptability, ease of comprehension, and perceived usefulness for the caregivers. It has adequate internal consistency, reliability, and construct and empirical validity.

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          Patients with lower activation associated with higher costs; delivery systems should know their patients' 'scores'.

          Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.
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            Rethinking health-care systems: a focus on chronicity.

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              Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care

              Introduction: The experience of chronic patients with the care they receive, fuelled by the focus on patient-centeredness and the increasing evidence on its positive relation with other dimensions of quality, is being acknowledged as a key element in improving the quality of care. There are a dearth of accepted tools and metrics to assess patient experience from the patient’s perspective that have been adapted to the new chronic care context: continued, systemic, with multidisciplinary teams and new technologies. Methods: Development and validation of a scale conducting a literature review, expert panel, pilot and field studies with 356 chronic primary care patients, to assess content and face validities and reliability. Results: IEXPAC is an 11+1 item scale with adequate metric properties measured by Alpha Chronbach, Goodness of fit index, and satisfactory convergence validity around three factors named: productive interactions, new relational model and person’s self-management. Conclusions: IEXPAC allows measurement of the patient experience of chronic illness care. Together with other indicators, IEXPAC can determine the quality of care provided according to the Triple Aim framework, facilitating health systems reorientation towards integrated patient-centred care.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                18 September 2018
                September 2018
                : 15
                : 9
                : 2040
                Affiliations
                [1 ]Health Psychology Department, Universidad Miguel Hernández de Elche, Comunidad Valenciana, 03202 Elche, Spain; jose.mira@ 123456umh.es
                [2 ]Programa Pacient Expert Catalunya ®, Programa de Prevenció i Atenció a la Cronicitat Direcció General de Planificació i en Salut, Departament de Salut, Cataluña, 08028 Barcelona, Spain; pamil@ 123456gencat.cat (P.A.); assumpcio_gonzalez@ 123456gencat.cat (A.G.-M.); egils@ 123456gencat.cat (E.G.-S.); jccontel@ 123456gencat.cat (J.C.C.)
                [3 ]Servei de Valoracions, Sub-Direcció General d’Atenció i de Promoció de l’Autonomia Personal Direcció general de Protecció Social, Departament de Treball, Afers Socials i Famílies, Cataluña, 08019 Barcelona, Spain; avilar@ 123456gencat.cat
                [4 ]Osakidetza, Servicio Vasco de Salud, País Vasco, 01006 Vitoria-Gasteiz, Spain; juancarlos.ansoteguiperez@ 123456osakidetza.eus (J.C.A.); mariateresa.bacigalupeartacho@ 123456osakidetza.eus (M.T.B.)
                [5 ]Consultora de Políticas Públicas y Gestión de Organizaciones, Castilla la Mancha, 45112 Toledo, Spain; olgasolasg@ 123456gmail.com
                [6 ]Merck Sharp & Dohme (MSD), 28027 Madrid, Spain; paloma_fernandezcano@ 123456merck.com
                [7 ]Fundación Vasca de Innovación Sanitaria, País Vasco, 48902 Bilbao, Spain; marteagoitia@ 123456bioef.org
                [8 ]Alicante-Sant Joan Health District, Comunidad Valenciana, 03550 Alicante, Spain
                [9 ]REDISSEC, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Comunidad Valenciana, 46020 Valencia, Spain
                Author notes
                [* ]Correspondence: mguilabert@ 123456umh.es
                Author information
                https://orcid.org/0000-0002-0706-9911
                https://orcid.org/0000-0001-6497-083X
                Article
                ijerph-15-02040
                10.3390/ijerph15092040
                6165505
                30231535
                b9e87acf-5f7c-43b9-9c6f-4a462ba4a8ee
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 July 2018
                : 15 September 2018
                Categories
                Article

                Public health
                caregivers,chronic disease,quality assurance,health services evaluation
                Public health
                caregivers, chronic disease, quality assurance, health services evaluation

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