Evaluating Patient Experience in a Rural-Serving Nephrology Clinic: Psychometric assessment of the consideRATE questions and assessment of care experience

BackgroundThe illness experiences of people with kidney disease are not systematically ascertained as part of clinical care. We conducted the first real-world psychometric evaluation of the consideRATE questions among patients with kidney disease and assessed healthcare experiences in a rural hospital setting. MethodsWe conducted a cross-sectional survey with a sample of patients with kidney disease and their care partners. Our survey consisted of demographic questions, consideRATE (8-items) to measure healthcare experience, and CANHELP-Lite (21-items) as a reference for consideRATE psychometric assessment. We scored consideRATE as continuous (range: 1-4) and top-box (score=4). We conducted internal reliability (Cronbachs alpha) and validity (convergent and discriminant using Pearsons correlation) tests. We compared mean consideRATE scores between paired subgroups using t-tests. We examined the relationship between rurality and healthcare experience using a multivariable linear regression model and rural-urban commuting area codes. ResultsWe recruited 163 participants, including 52 who lived in rural areas. The mean consideRATE score was 3.65 (SD=0.42), and the top-box score was 35% (n=59). Internal consistency for consideRATE was 0.86. We demonstrated convergent validity (continuous: r=0.5, p<0.001 and top-box: r=0.3, p<0.001) and discriminant validity (continuous: r=0.1, p>0.05 and top-box: r=0.1, p>0.05). Subgroup analyses revealed no significant differences in overall consideRATE scores by rurality status, state of residence, travel time, and gender. After adjustment for demographics, lower continuous mean consideRATE scores were significantly associated with longer travel time to the clinic (p<0.01), religious affiliation (p<0.05), and age over 55 years (p<0.01). We found no significant association between total consideRATE score and rurality. ConclusionWe found validity in the first real-world psychometric assessment of consideRATE among people with kidney disease and found associations between healthcare experience and various demographic variables.