Development of the COMET tool: Caregiver‐reported Outcome Measure for Emergency care Transitions
Cameron Gettel, James Galske, Ivie Uzamere, Peter Serina, Kizzy Hernandez‐Bigos, Sahil Mane, Kelly Chen, Sierra Ottilie‐Kovelman, Jacqueline Sandoval, Arjun Venkatesh, Andrew Cohen, Joan Monin, Terri Fried, Ula Hwang- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Despite a recognized need for more robust metrics, caregiver‐reported outcome measures have not been developed for care partners of persons living with cognitive impairment (PLWCI) navigating emergency department (ED)‐to‐community care transitions. Our objective was to develop the Caregiver‐reported Outcome Measure for Emergency care Transitions (COMET) tool through a 5‐phase process.
Methods
The study was conducted in four EDs and included care partners of PLWCI discharged from the ED identified by validated screening tools. In Phase 1, 25 participants completed semi‐structured interviews to identify barriers experienced during ED‐to‐community care transitions. In Phase 2, research team members performed item generation, in which candidate items were developed through findings from Phase 1 qualitative interviews and adaptation of items on existing outcome measures. In Phase 3, we utilized member checking, in which 27 new participants ranked candidate items they felt important for inclusion within the final COMET tool. Phase 4 included 10 cognitive debriefing interviews, in which participants assessed candidate items for comprehensiveness, content validity, and comprehension. In Phase 5, 19 multidisciplinary stakeholders participated in a modified Delphi approach to generate the COMET tool.
Results
Phase 1 identified four major barriers experienced by care partners of PLWCI during ED‐to‐community care transitions: 1) unique care considerations while in the ED setting impact the perceived success of the care transition, 2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, 3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and 4) navigating the health care system after an ED encounter was perceived as difficult by care partners. Phase 2 generated 50 candidate items grouped into 3 domains: discharge process, care transition, and impact on the caregiver. Phase 3 quantitatively identified high‐ and low‐scoring candidate items for inclusion in the final COMET tool. Phase 4 resulted in revisions to the wording of several candidate items. Phase 5 resulted in the 19‐item COMET tool.
Conclusions
Development of the COMET tool will provide a means for caregiver‐centric outcome assessment of interventions targeting ED‐to‐community care transitions among PLWCI.