A new measure of quality of care experience in aged care: psychometric assessment and validation of the Quality of Care Experience (QCE) questionnaire

Executive Summary
 This report describes the methods and findings from a study to investigate the psychometric
properties and validity of a new measure of the Quality of Care Experience (QCE) developed by
the Caring Futures Institute at Flinders University. The psychometric properties and validity of
the QCE were assessed using two separate datasets collected through surveys of aged care
residents and home care clients. The surveys were led by the National Ageing Research Institute
(NARI) for the Royal Commission into Aged Care Quality and Safety, with results published in the
Royal Commission’s Research Papers 13 and 14.
 The QCE comprises 6 key attributes reflecting the extent to which the person is treated with
respect and dignity; supported to make their own decisions about care and services; receives
aged care services from staff who have appropriate skills and training; receives services and
support for daily living that are important for health and wellbeing; supported to maintain social
relationships and connections; and comfortable lodging complaints with confidence that
appropriate action will be taken. Each is measured with a 5-point Likert type response scale
indicating the extent to which each attribute is achieved (never, rarely, sometimes, mostly,
always).
 Comprehensive psychometrics and validity assessments have been conducted on the QCE and
are described in this report. The assessments demonstrate the psychometric properties and
validity of the QCE questionnaire as a fit for purpose tool to assess the quality of care experience
from the perspective of older people and family carers in residential aged care and home care
settings.
 For the residential aged care sample, higher QCE scores (indicating a better quality of care
experience) were statistically significantly associated (P<0.001) with higher scores on the
Consumer Choice Index (CCI-6D, a validated measure of care quality for long-term care)
indicating the construct validity (demonstration that the QCE measures the quality of care
construct that it purports to measure) of the QCE measure in residential care settings.
 For the home care sample, participants reporting higher social care-related quality of life as
measured by the Adult Social Care Outcome Toolkit (ASCOT), and higher psychological-need
related quality of life measured by the CASP-12, generally exhibited higher scores for the QCE
(i.e. better quality of care experience) providing evidence of the construct validity of the QCE in
home care settings.
 In both the residential and home care samples, higher life satisfaction as measured by the Global
Life Satisfaction Scale was associated with higher quality of care experience measured by the
QCE and vice versa.
 Proxies reported a significantly lower QCE in both home and residential aged care samples,
indicating that proxies generally perceived lower quality of care experience in comparison with
older people themselves. These findings add to a growing body of evidence of differences between proxy-reports and self-reports of quality of care experience and quality of life in aged
care, with proxies tending to report lower scores on average on both these indicators across a
variety of validated measures.
 Respondents who expressed concerns about the aged care services they were receiving tended
to score lower on the QCE and the higher the number of concerns the lower the QCE scores on
average indicating a lower quality of care experience.
 For the residential care sample, females exhibited statistically significantly (P=0.04) higher QCE
scores than males, indicating that females perceived a better quality of care experience than
males. Similarly, higher QCE scores were observed for females relative to males for the home
care sample but these differences were not statistically significant (P=0.69).