CAHPS® Patient Experience Surveys

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Slide 1

CAHPS [Consumer Assessment of Healthcare Providers and Systems] Patient Experience Surveys
AHRQ Annual Meeting
September 2012

Christine Crofton, PhD
CAHPS Project Officer

Slide 2

Overview of the Afternoon

• Overview of CAHPS Surveys/Design Principles.
• Update from CMS [Centers for Medicare & Medicaid Services] on Use of CAHPS Surveys.
• QI Resources and Survey Updates.
• Reporting in a World of Multiple CAHPS Measures.

Slide 3

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.

Slide 4

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.

Slide 5

The CAHPS Team

• Grantees, RAND and Yale.
• User Network Contractor (Contract to be awarded soon).
• Stakeholders from other government agencies, such as CMS, CDC [Centers for Disease Control and Prevention].
• Stakeholders from other private organizations, non-profits and advocacy groups.

Slide 6

CAHPS Ambulatory Care Surveys

• Health Plan Survey:
  • Adult and child.
  • Medicare, Medicaid & commercial.
  • Managed care, FFS [fee-for-service], PPO [preferred provider organization].
  • NCQA [National Committee for Quality Assurance] version.
  • Disenrollee.

Slide 7

CAHPS Ambulatory Care Surveys, cont'd

• Clinician & Group Survey:
  • Adult and child.
  • Visit-based and past 12 months versions.
  • 4 point and 6 point scale version.

Slide 8

CAHPS Ambulatory Care Surveys, cont'd 

• ECHO Survey (Behavioral Health Care).
• American Indian Survey.
• Home Health Care Survey.
• Surgical Care Survey.
• Dental Survey.

Slide 9

CAHPS Facility Surveys

Hospitals

Hemodialysis Facilities

Nursing Homes

• In-person interview for long-term residents.
• Recently discharged short-stay residents.
• Residents' family members.

Slide 10

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.

Slide 11

CAHPS Surveys

Image: Three text boxes show the following process: CAHPS Core Questionnaire Items + Supplemental Items = CAHPS Survey.

Slide 12

CAHPS Core Items

• Access: Getting Care Quickly.
• Access: Getting Needed Care.
• Communication with Doctors.
• Communication with Nurses.
• Helpfulness of Office Staff.
• Coordination of Care.

Slide 13

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.

Slide 14

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.

Slide 15

Discovering What Patients Want to Know

• Focus groups with members of target population.
• Focus groups with other individuals.
• Literature reviews.
• Environment scans.

Slide 16

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.

Slide 17

Principle 2: Reporting About Actual Experiences

Survey focus =

Patient experience of care
rather than simple satisfaction.

Slide 18

Principle 2: Reporting About Actual Experiences

Reports of experience are more:

• Actionable.
• Understandable.
• Specific.
• Objective.

  than general ratings.

Slide 19

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?

Slide 20

Principle 3: Standardization

Instrument:

• Every user administers items the same way.

Protocol:

• Sampling, communicating with potential respondents, and data collection procedures are standardized.

Slide 21

Principle 3: Standardization, cont'd

Analysis:

• Standardized programs and procedures.

Reporting:

• Standard reporting composites and presentation guidelines.

Slide 22

Principle 4: Multiple Versions for Diverse Populations

Designed for all types of users:

• Medicare.
• Medicaid.
• Commercial population.

In English and Spanish.

Slide 23

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.

Slide 24

Principle 5: Extensive Testing with Consumers, cont'd

Cognitive testing

• Participant 'thinks out loud' while completing the questionnaire.
• Participant is interviewed in detail after completing the questionnaire.

Slide 25

Principle 5: Extensive 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.