Measurement tools and outcome measures used in transitional patient safety; a systematic review

Background
Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of transitional patient safety, valid measurement tools are needed.
Aim and methods
To identify and appraise all measurement tools and outcomes that measure aspects of transitional patient safety, PubMed, Cinahl, Embase and Psychinfo were systematically searched. Two researchers performed the title and abstract and full-text selection. First, publications about validation of measurement tools were appraised for quality following COSMIN criteria. Second, we inventoried all measurement tools and outcome measures found in our search that assessed current transitional patient safety or the effect of interventions targeting transitional patient safety.
Results
The initial search yielded 8288 studies, of which 18 assessed validity of measurement tools of different aspects of transitional safety, and 191 assessed current transitional patient safety or effect of interventions. In the validated measurement tools, the overall quality of content and structural validity was acceptable; other COSMIN criteria, such as reliability, measurement error and responsiveness, were mostly poor or not reported. In our outcome inventory, the most frequently used validated outcome measure was the Care Transition Measure (n = 9). The most frequently used non-validated outcome measures were: medication discrepancies (n = 98), hospital readmissions (n = 55), adverse events (n = 34), emergency department visits (n = 33), (mental or physical) health status (n = 28), quality and timeliness of discharge summary, and patient satisfaction (n = 23).
Conclusions
Although no validated measures exist that assess all aspects of transitional patient safety, we found validated measurement tools on specific aspects. Reporting of validity of transitional measurement tools was incomplete. Numerous outcome measures with unknown measurement properties are used in current studies on safety of care transitions, which makes interpretation or comparison of their results uncertain.

背景：
患者在接受不同医疗机构的医护人员同时提供的诊疗服务时，面临发生伤害的风险。为了评估当前的转诊患者安全（transitional patient safety）现状并优化其改进措施，亟需经过效度验证的测量工具。

研究目的与方法：
为识别并评价所有用于衡量转诊患者安全各维度的测量工具与结局指标，本研究系统检索了PubMed、Cinahl、Embase及Psychinfo数据库。由两名研究人员分别完成标题、摘要及全文的筛选工作。首先，依据COSMIN标准对测量工具效度相关的发表文献进行质量评价；其次，对本次检索中发现的、用于评估当前转诊患者安全状况或靶向转诊患者安全的干预措施效果的所有测量工具与结局指标进行编目。

研究结果：
初步检索共获得8288项研究，其中18项研究对转诊安全不同维度的测量工具效度进行了评估，191项研究评估了当前转诊患者安全状况或相关干预措施的效果。在经效度验证的测量工具中，内容效度与结构效度的整体质量尚可；其余COSMIN标准维度（如信度、测量误差及反应性）的报告质量大多较差，或未予报告。在本次结局指标编目中，最常使用的经验证结局指标为护理转诊度量表（Care Transition Measure）（n=9）。最常使用的未经验证的结局指标包括：用药不符（n=98）、医院再入院（n=55）、不良事件（n=34）、急诊就诊（n=33）、（精神或躯体）健康状况（n=28）、出院小结的质量与及时性，以及患者满意度（n=23）。

研究结论：
尽管目前尚无能够全面评估转诊患者安全所有维度的经验证测量工具，但本研究发现了可用于评估特定维度的经验证测量工具。当前对转诊相关测量工具效度的报告并不完整。现有转诊患者安全相关研究中，大量使用了测量属性未知的结局指标，这使得研究结果的解读与比较存在不确定性。