Development and preliminary testing of a patient reported experience measure for chronic disease patients in Singapore

Abstract

Background: Patient experience is invaluable for identifying gaps in the provision of healthcare. Patient-Reported Experience Measures (PREMs) are essential tools for evaluating the quality of care from the patient’s viewpoint. Research with PREMs in Asian countries is limited. We aimed to develop and test a Patient Reported Experience Measure for Singapore (PREM-SG) among chronic disease patients in the multi-ethnic population in Singapore. Methods: We carried out a nationwide cross-sectional household survey with a proportionate stratified by broad dwelling types random sampling in Singapore. Participants were Singapore citizens and permanent residents aged 45 years old or above and had at least one common chronic condition. A total of 1462 patients who completed the 13-item PREM-SG (English, Chinese, Malay) for their regular or most recently visited healthcare provider were included in the current analysis. Results: The PREM-SG had a unidimensional structure, and satisfactory reliability (Cronbach’s alpha = 0.89) and construct validity. Item response theory models revealed that two items (continuity, safety) discriminated poorly and had low item information (slopes < 0.7). Examining differential item functioning of the PREM-SG without these two items demonstrated measurement equivalence across genders. One item (coordination) elicited more positive ratings in the Chinese version compared to the English version given the same level of latent trait, without a substantially impact on the overall scores. Having a regular care provider, being of older age, and having better self-reported health was associated with higher PREM scores. Conclusions: Preliminary evidence documented satisfactory psychometric properties of PREM-SG for individuals (age 45+) with chronic conditions. Refinement and more research are needed to further evaluate the validity and usefulness of PREM-SG.