CAHPS PATIENT EXPERIENCE SURVEYS AHRQ ANNUAL MEETING SEPTEMBER 2012

1. CAHPS PATIENT EXPERIENCE SURVEYSAHRQ ANNUAL MEETINGSEPTEMBER 2012 Christine Crofton, PhD CAHPS Project Officer

2. 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

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

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

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 • Stakeholders from other private organizations, non-profits and advocacy groups

6. CAHPS Ambulatory Care Surveys • Health Plan Survey • Adult and child • Medicare, Medicaid & commercial • Managed care, FFS, PPO • NCQA version • Disenrollee

7. 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

8. CAHPS Ambulatory Surveys, cont’d • ECHO Survey (Behavioral Health Care) • American Indian Survey • Home Health Care Survey • Surgical Care Survey • Dental Survey

9. CAHPS Facility Surveys Hospitals Hemodialysis Facilities Nursing Homes • In-person interview for long-term residents • Recently discharged short-stay residents • Residents’ family members

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

11. CAHPS Surveys

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

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

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.

15. Discovering What Patients Want to Know • Focus groups with members of target population • Focus groups with other individuals • Literature reviews • Environment scans

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

17. Principle 2:Reporting About Actual Experiences Survey focus = Patient experience of care rather than simple satisfaction.

18. Principle 2:Reporting About Actual Experiences Reports of experience are more: • Actionable • Understandable • Specific • Objective than general ratings.

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?

20. Principle 3: Standardization Instrument • Every user administers items the same way Protocol • Sampling, communicating with potential respondents, and data collection procedures are standardized

21. Principle 3: Standardization, cont’d Analysis • Standardized programs and procedures Reporting • Standard reporting composites and presentation guidelines

22. Principle 4: Multiple Versions for Diverse Populations Designed for all types of users • Medicare • Medicaid • Commercial population In English and Spanish

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

24. 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

25. 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