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01-08-2015 | Uitgave 8/2015

Quality of Life Research 8/2015

The use of cognitive interviews to revise the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM)

Quality of Life Research > Uitgave 8/2015
Niklas Bobrovitz, Maria J. Santana, Theresa Kline, John Kortbeek, Henry T. Stelfox
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s11136-015-0919-5) contains supplementary material, which is available to authorized users.



The “Quality of Trauma Care Patient-Reported Experience Measure” is the first measure of patient experiences with overall injury care. The objective of this study was to use cognitive interviews to inform revision of the measure into a parsimonious set of items that function as intended, in preparation for multicenter testing.


Concurrent and retrospective cognitive interviews with injured patients (n = 17) and family members (n = 13) using semi-structured interview guides. Responses were analyzed using thematic analysis.


Six broad themes were identified and guided revisions: (1) participants did not have the information to answer items (n = 9); (2) items were ambiguous or were inconsistently interpreted (n = 13); (3) items did not measure the intended constructs (n = 6); (4) items included assumptions about healthcare processes (n = 4); (5) items measured non-priority aspects of injury care (n = 8); and (6) items were redundant (n = 5). Two issues resulted in key conceptual and content changes: participants’ difficulty to evaluate pre-hospital, emergency department, and intensive care unit services due to recall issues and the challenge to evaluate the effectiveness and equity of care. In total, 39 items were deleted, 28 new items developed, and the final instrument included 63 items.


Our results informed changes to item content, format, and response options. This study highlights key issues to consider when incorporating patient/family perspectives into quality measurement, most notably, that few participants can assess the quality of care in the pre-hospital and emergency department phases of care and that novel methods are needed to evaluate the effectiveness and equity of care.

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Extra materiaal
Supplementary material 1 (DOCX 25 kb)
Supplementary material 2 (DOCX 43 kb)
Supplementary material 3 (PDF 112 kb)
Supplementary material 4 (PDF 123 kb)
Supplementary material 5 (PDF 150 kb)
Supplementary material 6 (PDF 157 kb)
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