Abstract

Background: Clinical coordination across health care levels is a health policy priority for health systems worldwide, particularly in those organised around primary health care. The COORDENA questionnaire was first developed in Latin America for measuring clinical coordination across health care levels. The objective of this study is to adapt and validate the COORDENA questionnaire and its application method for use in the public health system of Catalonia (Spain). Methods: The COORDENA questionnaire underwent a two-stage adaptation process for the context of the public health system of Catalonia: 1) literature review, expert discussions and two pre-tests to contextually adapt the language and contents of the questionnaire and produce an online version; and 2) piloting the adapted version of the questionnaire through an online survey of 161 doctors in a health care area of the public health system of Catalonia. Results: Most of the original questions were retained. An adequate level of comprehensiveness, understanding, acceptability, sequence of themes and questions, and length of the adapted questionnaire was observed in the pre-tests. The survey participation rate was 33.8%, with more primary care doctors participating than secondary care doctors. None of the questions presented a high no-response rate, low variability or unexpected responses. Results show that doctors report high levels of clinical information coordination and care coherence, as expected, in contrast with their limited general perception of coordination across care levels in the health care area that was analysed. Conclusion: The COORDENA questionnaire adapted for Catalonia, COORDENA-CAT, has proved to be a valid instrument to comprehensively evaluate clinical coordination across health care levels from the perspective of primary and secondary care doctors. It is relatively easy to adapt to new contexts and can be used to monitor, evaluate and benchmark health services within and across countries and to complement evaluation with other sources of information, such as indicators or the perspectives of patients.