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CAHPS PATIENT EXPERIENCE SURVEYSAHRQ ANNUAL MEETING
SEPTEMBER 2012
Christine Crofton, PhD
CAHPS Project Officer
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Overview of the afternoon
• Overview of CAHPS Surveys/Design Principles
• Update from CMS on Use of CAHPS Surveys
• QI Resources and Survey Updates
• Reporting in a World of Multiple CAHPS Measures
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What is CAHPS?
• An integrated set of products and strategies
• Through which users can obtain assessments of quality of care received by consumers and patients
• In a variety of health care settings
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How are CAHPS data used?
• Inform selection decisions
• Identify areas where providers and organizations can improve their services
• Provide quality information to care providers and other audiences
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The CAHPS Team
• Grantees, RAND and Yale• User Network Contractor
(Contract to be awarded soon)• Stakeholders from other government
agencies, such as CMS, CDC• Stakeholders from other private
organizations, non-profits and advocacy groups
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CAHPS Ambulatory Care Surveys
• Health Plan Survey– Adult and child– Medicare, Medicaid & commercial– Managed care, FFS, PPO– NCQA version– Disenrollee
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CAHPS Ambulatory Surveys, cont’d
• Clinician & Group Survey– Adult and child– Visit-based and past 12 months versions– 4 point and 6 point scale version
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CAHPS Ambulatory Surveys, cont’d
• ECHO Survey (Behavioral Health Care)• American Indian Survey • Home Health Care Survey• Surgical Care Survey• Dental Survey
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CAHPS Facility Surveys
Hospitals
Hemodialysis Facilities
Nursing Homes– In-person interview for long-term
residents– Recently discharged short-stay residents– Residents’ family members
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CAHPS Supplemental Item Sets
• Children with Chronic Conditions• People with Mobility Impairments• Health Literacy• Cultural Competence• Health Information Technology• Patient-Centered Medical Home
Additional item sets for:• Health Plan Survey• Clinician & Group Survey
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CAHPS Surveys
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CAHPS Core Questionnair
e Items
Supplemental Items
CAHPS Survey
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CAHPS Core Items
• Access: Getting Care Quickly• Access: Getting Needed Care• Communication with Doctors• Communication with Nurses• Helpfulness of Office Staff• Coordination of Care
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Principle 1: Emphasis on Patients
CAHPS surveys ask about aspects of care:
--For which patients are the best or only source
--Which patients have identified as important
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Principle 1:Emphasis on Patients
Only the patient knows:
• How well their pain was controlled during a hospital stay
• Whether a provider explained things in a way that was easy to understand
• How often the provider’s office staff treated him or her with courtesy and respect.
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Discovering What Patients Want to Know
• Focus groups with members of target population
• Focus groups with other individuals
• Literature reviews
• Environment scans
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Discovering What Patients Want to Know
• Interviews, meetings with key informants – Gatekeepers, providers, advocacy groups
• Stakeholders – Policy makers, health care quality orgs
• Technical expert panel members
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Principle 2:Reporting About Actual Experiences
Survey focus =
Patient experience of care rather than simple satisfaction.
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Principle 2:Reporting About Actual Experiences
Reports of experience are more:
– Actionable– Understandable– Specific– Objective
than general ratings.
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Principle 2:Reporting About Actual Experiences
How satisfied were you?vs.
How often did this provider:– Explain things in a way you could
understand?– Treat you with courtesy and respect?– Listen carefully to you?– Spend enough time with you?– See you within 15 minutes of appointment
time?
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Principle 3: Standardization
Instrument– Every user administers items the same way
Protocol– Sampling, communicating with potential
respondents, and data collection procedures are standardized
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Principle 3: Standardization, cont’d
Analysis– Standardized programs and procedures
Reporting– Standard reporting composites and
presentation guidelines
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Principle 4: Multiple Versions for Diverse Populations
Designed for all types of users– Medicare– Medicaid– Commercial population
In English and Spanish
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Principle 5: Extensive Testing with Consumers
Cognitive testing
– Confirms that items, response options are understood as developer intended
– Is conducted in iterative rounds
– In English and in Spanish
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Principle 5: Testing with Consumers, cont’d
Cognitive testing
– Participant ‘thinks out loud’ while completing the questionnaire
– Participant is interviewed in detail after completing the questionnaire
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Principle 5: Testing with Consumers, cont’d
Field testing
– To assess the effectiveness and feasibility of survey administration procedures and guidelines
– To determine validity, reliability and other psychometric properties