The First Episode Psychosis Services Fidelity Scale as a measure of Quality of Care

Background Fidelity scales are designed to assess the degree to which a program delivers the core components of evidence-based programs. The degree to which scales can predict outcomes—its predictive validity—is an important psychometric property. Fidelity scales have multiple applications including quality assurance and improvement. The purpose of this study was to assess the degree to which the First Episode Psychosis Services Fidelity Scale (FEPS-FS) assesses the six domains of quality of care described in the Institute of Medicine (IOM)’s quality of care framework. Study Design A quality thematic analysis using a theoretical (deductive) approach was used to categorize the 36 items of the FEPS-FS according to the framework for evaluating quality of care outlined by the IOM. Two coders independently reviewed and coded each item in duplicate. Frequency counts were used to summarize the characteristics of the FEPS-FS items across the IOM's quality domains. Study Results Most FEPS-FS items reflect effectiveness (47.2%), efficiency (19.59%) and patient-centeredness (18.56%). Safety (7.22%), timeliness (5.15%) and equity (2.06%) were relatively underrepresented. Conclusions The FEPS-FS can be considered as a measure of quality of care that covers all the IOM domains. As expected for a fidelity scale, the largest number of items assess effectiveness, while safety, timeliness and equity were represented by fewer items. We identified potential items from the literature that could be used to increase the proportion of items in underrepresented quality domains in future iterations of the FEPS-FS or other fidelity scales.