The CONECT‐6 case‐finding tool to identify patients with complex needs: A few tips to promote understanding

Patients with complex health and social care needs (hereafter "complex needs") often use services provided by different professionals, calling for integrated care to adequately meet their needs.1 In a previous publication,2 our team presented the COmplex NEeds Case-finding Tool—6 (CONECT-6), a case-finding tool including six yes or no questions, for early identification of people with complex needs who frequently use emergency department services. Even with the most robust psychometric properties, health assessment questionnaires often pose challenges for vulnerable populations, such as a lack of clarity or a lack of specificity to capture the respondents' unique and complex situations.3-6 It is good practice to provide respondents with some advice and guidelines to facilitate the questionnaires' administration and promote their understanding.6 This article aims to propose a few tips to ensure better understanding when administering CONECT-6 to people who frequently use emergency department services to identify if they have complex needs. The ongoing PriCARE Transitions project, funded by the Canadian Institutes of Health Research, aims to better understand the experience of care transitions of patients living with complex needs.7 Knowing that people with complex needs frequently use many health and social services and that emergency department visits are a good proxy of this use,8, 9 people with complex care needs were recruited in six emergency departments from three Canadian provinces (Quebec, New Brunswick, and Newfoundland and Labrador). The CONECT-6 tool was administered as a screening tool for complex needs to patients with three or more emergency visits in the previous year. Patients with two positive answers or more were then invited to complete the INTERMED Self-Assessment (IMSA)10 to confirm complex needs. A validation study of the CONECT-6 tool compared its responses against those in the IMSA,10 which is considered a gold standard for measuring complex needs. CONECT-6 validation documented a sensitivity of 90% and a specificity of 66% with a threshold of two or more positive answers, and a positive predictive value of 49% and a negative predictive value of 95%.2 Thus far, six participating emergency sites in the PriCARE Transitions study have recruited over 700 patients to complete the CONECT-6 screening tool either electronically or on paper. To overcome barriers of low literacy or reading challenges a researcher typically administered the questionnaire,11 but people who indicated that they were more comfortable self-administering the questionnaire could do so. As with many other validated questionnaires, many people raised questions regarding CONECT-6 despite its simple formula and previous validation.6 The most frequent challenges encountered across sites were: (1) for the first, third, and sixth items, people tended to elaborate on their specific situation, leaving the research team to either choose a 'yes' or 'no' option or to rephrase the question to elicit a 'yes' or 'no' response; and (2) the second and fifth items sometimes needed more explanation. The research team, including patient partners, met and shared strategies they used to facilitate respondents' understanding and proposed tips. English-speaking members of the team worked on the English version while French-speaking members worked on the French version. Teamwork and discussions ensured that the questionnaires maintained their original meaning. Here are the proposed tips to administer the CONECT-6 tool in Tables 1 and 2. In general, would you say your health is fair to poor, or would you say your health is better than that? If the patient answers better than that, the answer is no, otherwise, the answer is yes. If the patient asks for it, specify that all sources of income include employment income, benefits, annuities, investments, and scholarships. By household, we mean all the people who live under the same roof. Si le patient le demande, préciser que par toutes sources de revenus on inclut les revenus d'emploi, les prestations, les rentes et les bourses. Par ménage, on entend toutes les personnes qui habitent sous le même toit. This paper proposes tips to promote participant understanding when completing the CONECT-6 questionnaire. This 6-item questionnaire remains a useful case-finding tool to identify people with complex health and social needs in the emergency department for recruitment in research projects or in clinical programs. We thank the Canadian Institutes of Health Research for funding. The authors declare no conflict of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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