Patient's Insights and Views Observing Teams Questionnaire (PIVOT)

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Submitted by National Center... on Oct 7, 2016 - 4:16pm CDT

Henry, B.W.
Rooney, D.M.
Eller, S.
Vozenilek, J.A
McCarthy, D.M.

The PIVOT is a 16-item, self-report survey that asks patients to evaluate team behaviors (e.g., interactions, communications, coordination), as experienced in a recent visit to an emergency department.   Items were developed through a line of research that included exploratory interviews with patients and caregivers to identify areas for item development, a web-based survey of health care providers and patient advocates to structure the survey, and cognitive interviewing with patients and caregivers to finalize wording.  An underlying unitary construct ("teamwork") was proposed by the authors and largely supported by study results.  Aggregate PIVOT scores were moderately and positively correlated with a separate measure of patient satisfaction.  Developed and tested in emergency departments, the items are fairly generic and could be used in other clinical settings, such as obstetrics, intensive care, or ambulatory care.  Results are useful for quality improvement purposes.

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Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Observer-based (e.g., rubric, rating tool, 360 degree feedback)
Source of Data: 
Patients, clients
Notes for Data Sources: 

A total of 101 patients completed the survey.  All patients were recruited from a single institution (urban academic medical center).  Enrolled patients constituted a convenience sample from recruitment efforts made during the morning, afternoon, and early evening shifts over two months' time.   The refusal rate was relatively low (response rate = 86%).  The patients' mean length of stay in the ED was 4 hours, and barring the purpose of their ED visit, their self-reported health status tended to be good to excellent.

Instrument Content: 
Behaviors / skills
Patient / client satisfaction, experience of care
Notes for Content: 

All 16 items were proposed to measure a single underlying construct ("teamwork"), and were not formatted into categories.  Items generally measured patients' observations of team interactions with each other ("I thought the team enjoyed working together;" " coordination ("I felt the team members kept each other informed"); and interactions with the patient ("I felt as if team members talked in front of me as if I wasn't there").

In this study, three additional items were used to measure patients' overall perceptions of care quality: "Patient Perception Scale" ("PPS").

Instrument Length: 

The PIVOT contains16 items, the PPS contains 3 items; six additional items capture demographic information.  No information on time to complete.

Item Format: 
Both the PIVOT and PPS items are rated with a 5-point scale measuring the frequency with which behaviors were observed (1 = "not at all," 5 = "all the time"), with an added "no opportunity to observe."
Unclear from the article, but likely administered and completed onsite prior to the patient's department from the ED.
Four of the items are reverse scored. Aggregate item scores are totaled for a total team score.
Subscription (can be viewed in journal article)
Notes on Access: 

Contact the author to confirm permission to use.

Psychometric Elements: Evidence of Validity
See previous studies for information related to item development via interviews with patients and caregivers, further survey construction via a web-based survey of health care providers and patient advocates. In the current study, Rasch item-measure correlations were examined to determine the extent to which all items measured a single construct, "teamwork." All but one item had a mean-square outfit statistic below 2.0, which confirmed their hypothesis.
Response Process: 
In the J Participatory Medicine feasibility study (2013), the authors used the tenets of the Plain Language Initiative (see National Institute of Health website) when writing items (e.g., they used full sentences, every day words, personal pronouns, active voice, and parallel construction). They held three rounds of cognitive interviews with patients and caregivers to determine the final wording for all items and response scales.
Internal Structure: 
Cronbach's alpha estimate for 16 items was r = 0.87 and the intraclass correlation was 0.85.
Relation to Other Variables: 
The summed PIVOT scores were moderately and positively correlated with the PPS total: r = 0.43, p <0.01.
None described.