CAHPS Overview Clinician & Group Surveys: Practical Options

for Implementation and Use

AHRQ ANNUAL MEETINGSEPTEMBER 18, 2011

Christine Crofton, PhD

CAHPS Project Officer

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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

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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

CAHPS Surveys

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CAHPS Core Questionnai

re 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

• 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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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

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Obtaining technical assistance

Free!

– Products• Surveys and Instructions (

http://www.cahps.ahrq.gov)

– CAHPS Technical assistance• Help Line (1.800.492.9261)• E-mail Help (cahps1@ahrq.gov)