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The Care Process Self-Evaluation Tool: a valid and reliable instrument for measuring care process organization of health care teams

Deborah Seys1, Svin Deneckere1, Walter Sermeus1, Eva Van Gerven1, Massimiliano Panella2, Luk Bruyneel1, Timothy Mutsvari34, Rafaela Camacho Bejarano5, Seval Kul6 and Kris Vanhaecht17*

Author Affiliations

1 Department of Public Health, Center for Health Services and Nursing Research, University of Leuven, Kapucijnenvoer 35 4th Floor, Leuven B-3000, Belgium

2 Department of Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy

3 L-Biostat, KU Leuven, Leuven, Belgium

4 Hasselt Universiteit, Hasselt, Belgium

5 Department of Nursing, Universidad de Huelva, Huelva, Spain

6 Department of Biostatistics, Faculty of Medicine, Gaziantep University, Sahinbey, Gaziantep, Turkey

7 Western Norway Research Network on Integrated Care, Helse Fonna, Haugesund, Norway

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BMC Health Services Research 2013, 13:325  doi:10.1186/1472-6963-13-325

Published: 19 August 2013



Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table.


The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated.


CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated.


The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams.

Psychometric properties; Care process; Organization of care; Validity; Reliability; Health care teams; CPSET; Multidisciplinary teams; Multicenter study