CAHPS Overview Clinician & Group Surveys: Practical Options for Implementation and Use

On September 18, 2011, Christine Crofton made this presentation at the 2011 Annual Conference.

Slide 1

CAHPS Overview
Clinician & Group Surveys: Practical Options for Implementation and Use

AHRQ Annual Meeting
September 18, 2011

Christine Crofton, PhD
CAHPS Project Officer

Slide 2

Overview of the afternoon

• Overview of CAHPS Surveys & Design Principles.
• CAHPS Clinician & Group Survey: An Introduction to the 2.0 Version.
• Implementing CAHPS C&G Surveys: Strategies and Opportunities.

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Overview, Cont'd

• Assessing CAHPS C&G Survey Results: What the CAHPS Databases Can Do for You.
• Improving Patient Experience in Primary Care: Resources & Examples including the CAHPS Survey for the Patient-Centered Medical Home.

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Overview, Cont'd

• Reporting on Patients' Experiences with Primary Care: Resources & Examples.

Slide 5

CAHPS

• Integrated system of products and strategies.
• Obtain assessments from consumers of the quality of care that they receive in different settings which.
• 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, currently RAND and Yale.
• User Network Contractor, currently Westat.
• AHRQ staff.
• Stakeholders from other government agencies, such as CMS, NIDDR, 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.
  • Patient Centered Medical Home.

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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.

Additional item sets for:

• Health Plan Survey.
• Clinician & Group Survey.

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CAHPS Surveys

CAHPS Core Questionnaire Items + Supplemental Items = CAHPS Survey

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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 (Continued)

• 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 (Continued)

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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Standardization: Recommended Data Collection Protocols

Dual mode data collection:

1. Advance notification letter.
2. 1st mailing of questionnaire packet.
3. Reminder post card.
4. Replacement mailing of questionnaire packet.
5. Offer telephone interviews to mail nonresponders.

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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.

Slide 27

Obtaining Technical Assistance

Free!

• Products:
  • Surveys and Instructions:
    (https://cahps.ahrq.gov)
• CAHPS Technical assistance:
  • Help Line (1.800.492.9261).
  • E-mail Help (cahps1@ahrq.gov)