Patient Reports about Health IT

Developing & Field Testing Survey Questions for Outpatient Settings

Keith McInnesBoston University School of Public Health &

VA Bedford Medical Center

Outline

• Background• Item Development• Illustrative Items• Field Testing

– Methods– Sample descriptive statistics

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Background

• Growing use of health IT– Electronic health records– Providers using computers during patient visit– Eprescribing– Patient portals/personal health records

• Unknown how it affects patient experience of care

• Interest in developing supplemental items for CAHPS surveys

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Consumer Assessment of Healthcare Providers and Systems (CAHPS®)

• Standardized surveys to– Assess patient-centered care – Compare and report on performance – Improve quality of care – Patient is the best source of information

• Supplemental items vs. “core” items• Clinician & Group Survey

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Development Process

• AHRQ stakeholder meeting 2006• Literature review• Focus groups• Develop item inventory• Expert interviews (CIOs, health IT experts, PHR

managers)• Cognitive interviews• Identification of field test sites

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Survey Content

Access to Care• Core: In the last 12 months when you made an appointment

for a check-up or routine care with this doctor, how often did you get an appointment as soon as you thought you needed?

• Health IT: In the last 12 months, when you used e-mail or a website to get an appointment at this doctor’s office, how often did you get an appointment as soon as you thought you needed?

Response Options: Never, Sometimes, Usually, Always

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Survey Content (cont.)

Getting Information• Core: In the last 12 months, when you phoned this doctor’s

office during regular office hours, how often did you get an answer to your medical question the same day?

• Health IT: In the last 12 months, when you e-mailed this doctor’s office, how often did you get an answer to your medical question as soon as you needed?

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Survey Content (cont.)

Prescription Medicines

• Health IT: In the last 12 months, did you ever use email or a website to ask this doctor’s office to refill or renew one of your prescriptions?

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Survey Content (cont.)

Patient use of website or portal• Health IT: In the last 12 months, how often were these lab or

other test results presented in a way that was easy to understand? (lab results)

• Health IT: In the last 12 months, how often was the list of prescription medicines up to date?(Eprescribing)

• Health IT: In the last 12 months, how often were the visit notes easy to understand? (After visit summary)

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Survey Content (cont.)

Provider use of computer• Health IT: During your visits in the last 12 months, did this

doctor ever use a computer or handheld device to show you information?

• Health IT: During your visits in the last 12 months, did this doctor’s use of a computer or handheld device make it harder or easier for you to talk with him or her?

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Survey Content (cont.)Doctor Communication• Core: In the last 12 months, how often did this doctor explain

things in a way that was easy to understand?

Staff• Core: In the last 12 months, how often did clerks and

receptionists at this doctor’s office treat you with courtesy and respect?

Shared Decision Making• Core (supplemental): In the last 12 months, did this doctor

talk with you about the pros and cons of each choice for your treatment or your health?

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Field Testing

• Beth Israel Deaconess Medical Center, Boston• Group Health Cooperative, Washington State• Kaiser Permanente Southern California

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Field Testing - Overview

Beth Israel (BIDMC)

Group Health (GHC)

Kaiser Permanente

(KPSC)

Site Description 1 Medical Center9 outpatient

clinics2 Medical Centers

Number of MDs selected

19 20 30

Patients per physician

125 125 120

Mode Internet Mail Internet, then Mail

Completes (response) 1,115 ( 48%) 1,631 (65% ) 1,896 ( 53%)

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Age and GenderBIDMC (%) GHC (%) KPSC (%)

Age

18-34 yrs 9 8 7

35-44 yrs 14 9 9

45-54 yrs 24 16 18

55-64 yrs 30 31 29

65-74 yrs 17 23 23

75 or older 6 14 14

Female 57 62 57

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EducationBIDMC (%) GHC (%) KPSC (%)

Less than HS 1 2 1

HS graduates 4 9 11

Some college 16 26 374-yr college

graduate 27 22 22More than 4-yr

college 53 41 30

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Race / Ethnicity

a American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander

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BIDMC (%) GHC (%) KPSC (%)

Hispanic 1 2 8

Non-Hispanic

White 92 85 82

Black 2 3 3

Asian 4 7 6

Othera 1 3 1

Health Status – Self-RatingBIDMC (%) GHC (%) KPSC (%)

Poor 2 2 2

Fair 9 9 13

Good 31 36 34

Very Good 40 38 36

Excellent 19 15 15

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Acknowledgements• AHRQ• BIDMC, GHC, KPSC• Julie A. Brown• Paul D. Cleary• Carol Cosenza• Lin Ding• Patricia Gallagher• John Halamka• Ron Hays• Mimi Hugh• Michael Kanter• James Ralston• Carl Serrato

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