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Journal of Health Innovation and Environmental Education

an Open Access Journal

Development and Validation of an Integrated Electronic Patient Progress Note-Based Healthcare Evaluation Instrument for Diabetes Management

István Fedor
University of Debrecen ROR
Hungary
istvanfed@gmail.com
Taisia Chertenko
Kharkiv Medical Academyiof Postgraduate Education
Ukraine
Junhong Kim
Pohang University of Science and Technology (POSTECH)
Korea, Republic of
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  • Purpose of the study: This research sought to design and rigorously evaluate an Integrated Electronic Progress Note instrument intended to support frailty risk monitoring and strengthen care coordination among older adults.

    Methodology: A methodological research approach was undertaken, beginning with conceptual framework development and item generation, followed by expert review for content adequacy and empirical validation. Data were obtained from 210 healthcare professionals alongside 320 de-identified electronic progress notes collected at Uzsoki Street Hospital. Psychometric evaluation included content validity indexing, internal consistency assessment, and construct validation using Partial Least Squares Structural Equation Modeling with bootstrapping procedures to test structural relationships.

    Main Findings: The developed instrument demonstrated high content agreement among experts (S-CVI = 0.93) and strong reliability indicators, with composite reliability values exceeding 0.90. Convergent validity met recommended thresholds (AVE > 0.50), while discriminant validity was confirmed through HTMT ratios below 0.90. The structural analysis indicated that the model accounted for 68% of the variance in documentation quality (R² = 0.68) and showed meaningful predictive capability (Q² = 0.49). Among the examined constructs, Care Coordination exerted the most substantial positive influence on documentation quality (β = 0.41, p < 0.001). Furthermore, improved documentation performance was significantly linked to a lower likelihood of 30-day readmission (β = –0.32, p < 0.01).

    Novelty/Originality of this study: This study presents a validated multidimensional measurement tool that connects frailty risk assessment elements with the quality evaluation of electronic clinical documentation, thereby advancing the integration of geriatric clinical assessment and digital health governance frameworks.

  • How to cite

    Development and Validation of an Integrated Electronic Patient Progress Note-Based Healthcare Evaluation Instrument for Diabetes Management. (2026). Journal of Health Innovation and Environmental Education, 3(1), 73-84. https://doi.org/10.37251/jhiee.v3i1.2671

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    1. M. J. Prince et al., “The burden of disease in older people and implications for health policy and practice,” Lancet, vol. 385, no. 7, pp. 549–562, 2015, doi: 10.1016/S0140-6736(14)61347-7. DOI: https://doi.org/10.1016/S0140-6736(14)61347-7
    2. M. Karthika, J. Abraham, P. B. Kodali, and E. Mathews, “Emerging Trends of Chronic Diseases and Their Care Among Older Persons Globally BT - Handbook of Aging, Health and Public Policy: Perspectives from Asia,” Rajan, S.I. (eds) Handbook of Aging, Health and Public Policy. Springer; Singapore, pp. 641–664, 2025 doi: 10.1007/978-981-99-7842-7_198. DOI: https://doi.org/10.1007/978-981-99-7842-7_198
    3. S. Naja, M. M. E. D. Makhlouf, and M. A. H. Chehab, “An ageing world of the 21st century: A literature review,” Int. J. Community Med. Public Heal., vol. 4, no. 12, pp. 43–53, 2017, doi: 10.18203/2394-6040.ijcmph20175306. DOI: https://doi.org/10.18203/2394-6040.ijcmph20175306
    4. S. Sciacchitano et al., “To be frail or not to be frail: This is the question a critical narrative review of frailty,” J. Clin. Med., vol. 13, no. 3, pp. 721–730, 2024, doi: 10.3390/jcm13030721. DOI: https://doi.org/10.3390/jcm13030721
    5. D. Kwak and L. V. Thompson, “Frailty: Past, present, and future?,” Sport. Med. Heal. Sci., vol. 3, no. 1, pp. 1–10, 2021, doi: 10.1016/j.smhs.2020.11.005. DOI: https://doi.org/10.1016/j.smhs.2020.11.005
    6. C. Ruggiero, “Understanding Aging, Frailty, and Resilience,” Practical Issues in Geriatrics. Springer, Cham, pp. 49–66, 2024, doi: 10.1007/978-3-031-77707-3_5. DOI: https://doi.org/10.1007/978-3-031-77707-3_5
    7. E. Moran, J. Kubale, G. Noppert, R. Malosh, and J. Zelner, “Inequality in acute respiratory infection outcomes in the United States: A review of the literature and its implications for public health policy and practice,” MedRxiv, vol. 26, vol. 4, pp. 1-47, 2020. doi: 10.1101/2020.04.22.20069781. DOI: https://doi.org/10.1101/2020.04.22.20069781
    8. A. Steel, D. F. Gallego-Perez, and T. Kuchenmüller, “Integration of traditional, complementary, and integrative medicine in the institutionalization of evidence-informed decision-making: The world health organization meeting report,” J. Integr. Complement. Med., vol. 31, no. 4, pp. 388–394, 2025, doi: 10.1089/jicm.2024.0837. DOI: https://doi.org/10.1089/jicm.2024.0837
    9. Y. K.M and S. P. Gudur, “Strategic approaches to managing respiratory tract infection risk factors: A comprehensive review,” Asian J. Hosp. Pharm., vol. 4, no. 1, pp. 1–8, 2024, doi: 10.38022/ajhp.v4i1.80. DOI: https://doi.org/10.38022/ajhp.v4i1.80
    10. Y. R. Ho, B. Y. Chen, and C. M. Li, “Thinking more wisely: Using the Socratic method to develop critical thinking skills amongst healthcare students,” BMC Med. Educ., vol. 23, no. 1, pp. 1–16, 2023, doi: 10.1186/s12909-023-04134-2. DOI: https://doi.org/10.1186/s12909-023-04134-2
    11. N. Jeffery et al., “A comparative analysis of teaching and evaluation methods in nurse practitioner education programs in Australia, Canada, Finland, Norway, the Netherlands and USA,” Int. J. Nurs. Educ. Scholarsh., vol. 17, no. 1, 2020, doi: 10.1515/ijnes-2019-0047. DOI: https://doi.org/10.1515/ijnes-2019-0047
    12. D. Paiva, L. Abreu, A. Azevedo, and S. Silva, “Patient‐centered communication in type 2 diabetes: The facilitating and constraining factors in clinical encounters,” Health Serv. Res., vol. 54, no. 3, pp. 623–635, Jun. 2019, doi: 10.1111/1475-6773.13126. DOI: https://doi.org/10.1111/1475-6773.13126
    13. H. Tuokko, L. E. Griffith, M. Simard, and V. Taler, “Cognitive measures in the canadian longitudinal study on aging,” Clin. Neuropsychol., vol. 31, no. 1, pp. 233–250, 2017, doi: 10.1080/13854046.2016.1254279. DOI: https://doi.org/10.1080/13854046.2016.1254279
    14. A. Whitney, “Thinking/feeling: Emotion, spectatorship, and the pedagogy of horror,” CEA Forum, vol. 43, no. 1, pp. 37–61, 2014,
    15. O. Kaplan, “Cross-cultural control–value mechanisms on the detrimental effect of bullying on mathematics anxiety,” Behav. Sci. (Basel)., vol. 16, no. 1, pp. 31–40, 2025, doi: 10.3390/bs16010003. DOI: https://doi.org/10.3390/bs16010003
    16. Y. Y. Tang, Z. Cui, and T. H. Kim, “The effects of scapular stabilization exercises accompanied by spine stabilization exercises using an unstable surface on muscle activities for subjects with scapular winging,” Int. J. Hum. Mov. Sport. Sci., vol. 11, no. 1, pp. 77–87, 2023, doi: 10.13189/saj.2023.110110. DOI: https://doi.org/10.13189/saj.2023.110110
    17. R. S. Haradanhalli, R. M. Prashanth, N. Kumari, I. Siddhareddy, P. D. P., and J. Surendran, “Personal hygiene practices and related skin diseases among primary school children of urban poor locality,” Int. J. Community Med. Public Heal., vol. 6, no. 6, pp. 2526–2532, 2019, doi: 10.18203/2394-6040.ijcmph20192316. DOI: https://doi.org/10.18203/2394-6040.ijcmph20192316
    18. H. M. Asim, A. Vaz, A. Ahmed, and S. Sadiq, “A review on outcome based education and factors that impact student learning outcomes in tertiary education system,” Int. Educ. Stud., vol. 14, no. 2, pp. 1-11, 2021, doi: 10.5539/ies.v14n2p1. DOI: https://doi.org/10.5539/ies.v14n2p1
    19. V. A. Kagonya, O. O. Onyango, M. Maina, D. Gathara, M. English, and A. Imam, “Characterising support and care assistants in formal hospital settings: A scoping review,” Human Resources for Health. vol. 21, no. 9, pp. 1-14, 2023 doi: 10.1186/s12960-023-00877-7 DOI: https://doi.org/10.1186/s12960-023-00877-7
    20. A. J. Kroopnick and E. C. Miller, “Approach to altered mental status in pregnancy and postpartum,” Semin. Neurol., vol. 44, no. 06, pp. 695–706, 2024, doi: 10.1055/s-0044-1788977. DOI: https://doi.org/10.1055/s-0044-1788977
    21. K. M. Baker, K. W. Stickney, and D. D. Sachs, “STEM cooperating teachers’ professional growth: The positive impacts of a year-long clinical residency collaboration,” Educ. Sci., vol. 14, no. 8, 2024, doi: 10.3390/educsci14080899. DOI: https://doi.org/10.3390/educsci14080899
    22. I. Notarnicola, M. Lommi, D. Ivziku, S. Carrodano, G. Rocco, and A. Stievano, “The nursing theory of complex adaptive systems: A new paradigm for nursing,” Healthcare, vol. 19, no. 12, pp. 1-11, 2024. doi: 10.3390/healthcare12191997. DOI: https://doi.org/10.3390/healthcare12191997
    23. E. M. Rosa, S. Sundari, E. R. Ambarwati, G. Suryandari, E. Rochmawati, and F. Suryanto, “‘E-matching card’ to improve cooperation and cognitive abilities among nursing students,” J. Keperawatan Indones., vol. 26, no. 2, pp. 89–96, 2023, doi: 10.7454/jki.v26i2.1136. DOI: https://doi.org/10.7454/jki.v26i2.1136
    24. C. Hurdle, L. Greenhaw, and R. Biderman, “Does autonomy improve satisfaction and performance? A case on learner choice,” NACTA J., vol. 68, no. 1, 2024, doi: 10.56103/nactaj.v68i1.178. DOI: https://doi.org/10.56103/nactaj.v68i1.178
    25. M. O. M. Idres et al., “Evaluating and improving the quality of clinical documentation using the background, subjective, objective, assessment, and plan (BSOAP) format: A clinical audit at el-gadarif teaching hospital,” Cureus, vol. 17, no. 8, pp. 1–6, 2025, doi: 10.7759/cureus.90580. DOI: https://doi.org/10.7759/cureus.90580
    26. B. Van Dusen and J. Nissen, “Associations between learning assistants, passing introductory physics, and equity: A quantitative critical race theory investigation,” Phys. Rev. Phys. Educ. Res., vol. 16, no. 1, pp. 101-117, 2020, doi: 10.1103/PHYSREVPHYSEDUCRES.16.010117. DOI: https://doi.org/10.1103/PhysRevPhysEducRes.16.010117
    27. P. A. Romero-García et al., “Complementary and Alternative Medicine (CAM) Practices: A Narrative Review Elucidating the Impact on Healthcare Systems, Mechanisms and Paediatric Applications,” Healthcare, vol. 12, no. 15, pp. 1547-1555, 2024, doi: 10.3390/healthcare12151547. DOI: https://doi.org/10.3390/healthcare12151547
    28. S. Barteit, D. Guzek, A. Jahn, T. Bärnighausen, M. M. Jorge, and F. Neuhann, “Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review,” Comput. Educ., vol. 145, 10, 573-580, 2019, 2020, doi: 10.1016/j.compedu.2019.103726. DOI: https://doi.org/10.1016/j.compedu.2019.103726
    29. M. Rifial, A. Razak, D. Darmawansyah, I. Indar, and A. Rahman, “Impact of health system usage, patient satisfaction, information quality, and service quality on hospital management information system utilization at madani regional general hospital,” J. Angiother., vol. 8, no. 11, pp. 1–8, 2024, doi: 10.25163/angiotherapy.81110061.
    30. C. Colucci et al., “Indexes, models and IT systems for frailty healthcare process management: An innovative case study,” Knowl. Process Manag., vol. 33, no. 1, pp. 25–48, 2026, doi: 10.1002/kpm.70005. DOI: https://doi.org/10.1002/kpm.70005
    31. R. Karnia, “Importance of Reliability and Validity in Research,” Psychol. Behav. Sci., vol. 13, no. 6, pp. 137–141, 2024, doi: 10.11648/j.pbs.20241306.11. DOI: https://doi.org/10.11648/j.pbs.20241306.11
    32. H. Ames, C. Glenton, and S. Lewin, “Purposive sampling in a qualitative evidence synthesis,” BMC Med. Res. Methodol, vol. 19, no. 1, pp. 1-26, 2019, doi: 10.1186/s12874-019-0665-4 DOI: https://doi.org/10.1186/s12874-019-0665-4
    33. A. H. Talal, E. M. Sofikitou, U. Jaanimägi, M. Zeremski, J. N. Tobin, and M. Markatou, “A framework for patient-centered telemedicine: Application and lessons learned from vulnerable populations,” J. Biomed. Inform., vol. 112, pp. 1-8, 2020, doi: 10.1016/j.jbi.2020.103622. DOI: https://doi.org/10.1016/j.jbi.2020.103622
    34. H. Fitriyani, Sarwi, and P. Marwoto, “The validity of collaborative based science learning model to develop students’ critical thinking skills,” in Proceedings of the 6th International Conference on Educational Research and Innovation (ICERI 2018), Paris, France: Atlantis Press,. 2019, pp. 271–276. doi: 10.2991/iceri-18.2019.58. DOI: https://doi.org/10.2991/iceri-18.2019.58
    35. E. K. Odjer and E. K. G. Mensah, “Maternal Mortality and Legal Accountability: Examining Government Responsibility for Preventable Deaths,” J. Law Crim. Justice, vol. 13, no. 3, pp. 49–73, 2025, doi: 10.15640/jlcj.v13p4. DOI: https://doi.org/10.15640/jlcj.v13p4
    36. H. T. U. N. Muthukumarana and R. V. S. P. K. Ranatunga, “Utilizing digital health technologies to improve patient experience and care quality in global healthcare: A systematic review,” Int. J. Digit. Heal. Telemed., vol. 1, no. 2, pp. 1–14, 2025, doi: 10.51137/wrp.ijdht.2025.hmui.45903. DOI: https://doi.org/10.51137/wrp.ijdht.2025.hmui.45903
    37. Y. A. Sherif, M. A. Hassan, M. Thuy Vu, T. K. Rosengart, and R. W. Davis, “Twelve Tips on enhancing global health education in graduate medical training programs,” Med. Teach., vol. 43, no. 2, pp. 142–147, 2021, doi: 10.1080/0142159X.2020.1762033. DOI: https://doi.org/10.1080/0142159X.2020.1762033
    38. T. U. Zaman, H. D. Goswami, and Y. Hassan, “The impact of growth and development of slums on the health status and health awareness of slum dwellers,” Int. J. Med. Res. Heal. Sci., vol. 7, no. 3, pp. 55–65, 2018.
    39. S. Rana, U. Tandon, and H. Kumar, “Understanding medical service quality, system quality and information quality of Tele-Health for sustainable development in the Indian context,” Kybernetes, vol. 53, no. 10, pp. 3232–3253, Oct. 2024, doi: 10.1108/K-01-2023-0005. DOI: https://doi.org/10.1108/K-01-2023-0005
    40. P. Adatara, A. Afaya, E. A. Baku, S. M. Salia, and A. Asempah, “Perspective of Traditional Birth Attendants on Their Experiences and Roles in Maternal Health Care in Rural Areas of Northern Ghana,” Int. J. Reprod. Med., vol. 2018, no. 10, pp. 1–10, 2018, doi: 10.1155/2018/2165627. DOI: https://doi.org/10.1155/2018/2165627
    41. A. S. M. Yasir, “Cross cultural adaptation & psychometric validation of instruments: Step-wise description,” Int. J. Psychiatry, vol. 1, no. 1, pp. 6–9, 2016, doi: 10.33140/ijp/01/01/00001. DOI: https://doi.org/10.33140/IJP/01/01/00001
    42. M. Rifial, A. Razak, D. Darmawansyah, I. Indar, and A. Rahman, “Impact of health system usage, patient satisfaction, information quality, and service quality on hospital management information system utilization at Madani regional general hospital,” J. Angiother., vol. 8, no. 11, pp. 1–8, 2024, doi: 10.25163/angiotherapy.81110061.. DOI: https://doi.org/10.25163/angiotherapy.81110061
    43. S. El-Den, C. Schneider, A. Mirzaei, and S. Carter, “How to measure a latent construct: Psychometric principles for the development and validation of measurement instruments,” Int. J. Pharm. Pract., vol. 28, no. 4, pp. 326–336, 2020, doi: 10.1111/ijpp.12600. DOI: https://doi.org/10.1111/ijpp.12600
    44. M. Eyo, “Digital divide in the utilization of information and communication technology (ICT) in counsellor education in Nigerian Universities,” Africa Educ. Rev., vol. 11, no. 2, pp. 91–102, 2014, doi: 10.1080/18146627.2014.927141. DOI: https://doi.org/10.1080/18146627.2014.927141
    45. P. U. Wijayanti, W. Windia, D. P. Darmawan, and W. Widhianthini, “Sustainable development model of subak in Denpasar City,” Int. J. life Sci., vol. 7, no. 4, pp. 246-251, 2020, doi: 10.29332/ijls.v4n1.418. DOI: https://doi.org/10.29332/ijls.v4n1.418
    46. M. Siarudin, S. A. Awang, R. Sadono, and P. Suryanto, “Renewable energy from secondary wood products contributes to local green development: The case of small-scale privately owned forests in Ciamis Regency, Indonesia,” Energy. Sustain. Soc., vol. 13, no. 1, pp. 1–19, 2023, doi: 10.1186/s13705-023-00383-7. DOI: https://doi.org/10.1186/s13705-023-00383-7
    47. P. Cantor, D. Osher, J. Berg, L. Steyer, and T. Rose, “Malleability, plasticity, and individuality: How children learn and develop in context,” Appl. Dev. Sci., vol. 23, no. 4, pp. 307–337, 2019, doi: 10.1080/10888691.2017.1398649. DOI: https://doi.org/10.1080/10888691.2017.1398649
    48. G. Sartore, E. Ragazzi, R. Caprino, and A. Lapolla, “Long-term HbA1c variability and macro-/micro-vascular complications in type 2 diabetes mellitus: A meta-analysis update,” Acta Diabetol., vol. 60, no. 6, pp. 721–738, 2023, doi: 10.1007/s00592-023-02037-8. DOI: https://doi.org/10.1007/s00592-023-02037-8
    49. J. K. Limberg et al., “Assessment of resistance vessel function in human skeletal muscle: guidelines for experimental design, doppler ultrasound, and pharmacology,” Am. J. Physiol. Circ. Physiol., vol. 318, no. 2, pp. H301–H325, 2019, doi: 10.1152/ajpheart.00649.2019. DOI: https://doi.org/10.1152/ajpheart.00649.2019
    50. O. Olakotan, R. Samuriwo, H. Ismaila, and S. Atiku, “Usability challenges in electronic health records: Impact on documentation burden and clinical workflow: A scoping review,” J. Eval. Clin. Pract., vol. 31, no. 4, pp. 8–18, 2025, doi: 10.1111/jep.70189. DOI: https://doi.org/10.1111/jep.70189
    51. L. A. Mukadar, T. Joko, and O. Setiani, “Liquid waste pollution load analysis home industry batik and the impact on the quality of river water in the sub-district of Pekalongan Selatan, Pekalongan city,” Int. J. Heal. Educ. Soc., vol. 4, no. 11, pp. 47–60, 2021, doi: 10.1234/ijhes.v4i11.206.
    52. C. Nuning Tiastiti, W. Fitria Ariyanti, M. M. Alquaimi, and W. L. Chiong, “Improving student learning outcomes in light and optical instruments using team teaching methods with crossword puzzle media,” Schrödinger J. Phys. Educ., vol. 5, no. 1, pp. 10–15, 2024, doi: 10.37251/sjpe.v5i1.881. DOI: https://doi.org/10.37251/sjpe.v5i1.881
    53. B. Y. Rizkiwati, S. U. M. Widjaja, A. Haryono, H. Wahyono, and M. Z. Majdi, “Financial literacy education models for 7–12 years old based on the local wisdom of sasak tribe Lombok Indonesia,” Pegem Egit. ve Ogr. Derg., vol. 12, no. 2, pp. 58–70, 2022, doi: 10.47750/pegegog.12.02.05. DOI: https://doi.org/10.47750/pegegog.12.02.05
    54. P. Kumar et al., “Using empirical science education in schools to improve climate change literacy,” Renew. Sustain. Energy Rev., vol. 178, no. 5, pp. 1132-1142, 2023, doi: 10.1016/j.rser.2023.113232. DOI: https://doi.org/10.1016/j.rser.2023.113232
    55. R. Fernande, V. Sridharan, and W. Kuandee, “Innovation learning with POE: Improve understanding student to equality square,” J. Educ. Technol. Learn. Creat., vol. 2, no. 1, pp. 20–28, 2024, doi: 10.37251/jetlc.v2i1.977. DOI: https://doi.org/10.37251/jetlc.v2i1.977
    56. J. S. Park and J. H. Park, “Advanced in algorithms, security, and systems for ICT convergence,” J. Inf. Process. Syst., vol. 16, no. 3, pp. 523–529, 2020, doi: 10.3745/JIPS.03.0141.
    57. S. Conti, Á. Dias, and L. Pereira, “Perceived City Sustainability and Tourist Behavioural Intentions,” Smart Cities, vol. 6, no. 2, pp. 692–708, 2023, doi: 10.3390/smartcities6020033. DOI: https://doi.org/10.3390/smartcities6020033
    58. I. Zsoldos-marchiș and É. Bálint-svella, “Development and preliminary testing of the algopaint unplugged computational thinking assessment for preschool education,” Acta Didact. Napocensia, vol. 16, no. 1, pp. 32–50, 2023, doi: 10.24193/adn.16.1.3. DOI: https://doi.org/10.24193/adn.16.1.3
    59. E. N. Setiyani, W. Panomram, and T. Wangdi, “Development of predict observe explain based flat side building worksheets to improve students’ mathematical representation skills,” Interval Indones. J. Math. Educ., vol. 2, no. 1, pp. 15–21, 2024, doi: 10.37251/ijome.v2i1.984. DOI: https://doi.org/10.37251/ijome.v2i1.984
    60. R. Rianti, G. Gunawan, N. N. S. P. Verawati, and M. Taufik, “The effect of problem based learning model assisted by phet simulation on understanding physics concepts,” Lensa J. Kependidikan Fis., vol. 12, no. 1, pp. 28-36, 2024, doi: 10.33394/j-lkf.v12i1.8783. DOI: https://doi.org/10.33394/j-lkf.v12i1.8783
    61. F. Troisi et al., “Zero-Fluoroscopy catheter ablation of right appendage focal atrial tachycardia in a pregnant woman,” Clin. Pract., vol. 14, no. 3, pp. 946–953, May 2024, doi: 10.3390/clinpract14030075. DOI: https://doi.org/10.3390/clinpract14030075
    62. R. M. Ryan and E. L. Deci, “Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions,” Contemp. Educ. Psychol., vol. 61, no. 4, pp. 386-396, 2020, doi: 10.1016/j.cedpsych.2020.101860. DOI: https://doi.org/10.1016/j.cedpsych.2020.101860