Validation and implementation of a patient-reported experience measure for patients with rheumatoid arthritis and spondyloarthritis in the Netherlands

Clin Rheumatol. 2020 Oct;39(10):2889-2897. doi: 10.1007/s10067-020-05076-6. Epub 2020 Apr 21.


Objectives: To test the psychometric properties of the United Kingdom's Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and to implement this questionnaire in daily practice in the Netherlands.

Methods: After a forward-backward translation procedure into Dutch, the CQRA-PREM was tested into two quality registries in daily practice. Face validity was assessed with focus group interviews. Feasibility was evaluated through completion times and interpretability of domain scores through floor and ceiling effects. Internal consistency (Cronbach's α coefficients) and homogeneity (corrected item-total correlations) were determined. Divergent validity was assessed by Spearman's rank correlation coefficients (rs) between the average scores of domains and outcome measures. The CQRA-PREM was implemented in daily practice, and the results were used in quality improvement cycles.

Results: Face validity of the CQRA-PREM was good. The CQRA-PREM was completed by 282 patients with SpA and 376 with RA. Median time to complete the CQRA-PREM was 4.7 min. Ceiling effects were found in three out of seven domains. Internal consistency of nearly all domains was considered good (0.65 ≤ α ≤ 0.95). Thresholds for homogeneity were exceeded within three domains (rp > 0.7), suggesting item redundancy. Divergent validity showed that nearly all domains of the CQRA-PREM were at most weakly correlated with outcomes measures (- 0.3 ≤ rs ≤ 0.3). The CQRA-PREM could identify areas of improvement for providing patient-centered care.

Conclusion: The CQRA-PREM has acceptable psychometric properties and has shown to be a useful tool in evaluating quality of care from the patients' perspective in the Netherlands.

Trial registration: SpA-Net is registered in the Netherlands Trial Registry (NTR6740).

Key points: • The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) is a valid measure for assessing patient-centeredness of rheumatology care. • The Dutch version of the CQRA-PREM shows acceptable psychometric properties. • The CQRA-PREM shows to be a useful tool in Plan-Do-Check-Act quality improvement cycles in the Netherlands. • The CQRA-PREM can be used for benchmarking and quality improvement of rheumatology services.

Keywords: Epidemiology; Outcome research; Patient perspective; Rheumatoid arthritis; Spondyloarthritis.

MeSH terms

  • Arthritis, Rheumatoid*
  • Humans
  • Netherlands
  • Patient Reported Outcome Measures
  • Psychometrics
  • Quality of Life
  • Reproducibility of Results
  • Spondylarthritis* / diagnosis
  • Surveys and Questionnaires