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Groundwork for ESRD CAHPS: The Feasibility Report. Beth Kosiak, Ph.D. Center for Quality Improvement and Patient Safety, AHRQ. CMS to AHRQ—Can One Patient Survey Serve Two Purposes?.

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Groundwork for ESRD CAHPS: The Feasibility Report

Beth Kosiak, Ph.D.

Center for Quality Improvement and Patient Safety, AHRQ

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CMS to AHRQ—Can One Patient Survey Serve Two Purposes?

  • CMS urged by IG, GAO, MedPAC, others to field a patient survey and publicly report results

  • CMS has been pursuing a quality agenda that includes both public reporting and internal quality improvement

  • Many facilities administer their own patient surveys for quality improvement and CMS wants to encourage such activity

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Answer: Maybe

  • Unlike other populations for which CAHPS surveys have been developed, in-center hemodialysis patients have a lot of experience with care, lots of observations to draw upon

  • This enables them to answer a broader range of questions with greater specificity; e.g., if needles sticks are painful, if the center is usually clean, if staff take precautions to prevent infection

  • These kinds of questions are interesting both to patients and facilities

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Background Research to Investigate the Question

  • Comprehensive literature review of patient surveys conducted, characteristics of the population relevant to survey administration (e.g., literacy levels, cognitive impairment, etc.)

  • Focus groups with patients and their families

  • Focus groups with nephrologists

  • Interviews with facility administrators and Network executives

  • Meeting with TEP to get input on content of survey (TEP composed of representatives from facilities, Networks, research, provider, and patient advocacy communities

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Major Findings (Purpose and Use of Survey)

  • Strong to moderate support for standardized survey, but concerns about losing valuable information from current surveys (especially since they are often a vehicle for communication with patients), burden and cost

  • Patients and professionals agree that if a patient survey is administered, improvement of care should occur

  • Professionals do not think comparative information will be usable for consumer choice but patients say they might switch to a higher rated facility

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Major Findings (Domains)

  • Communication

  • Education

  • Concern and helpfulness of staff

  • Patient (and family) involvement in care

  • Coordination of care

  • Patient perception of staff proficiency

  • Patient safety

  • Facility amenities and physical environment

  • Access and convenience of care

  • Handling of grievances and complaints

  • Interpersonal relationships in the dialysis center

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Major Findings (Methods and Survey Administration)

  • Site of survey administration (in the center, at home)

  • Low literacy levels, fatigue, cognitive impairment, poor vision

  • Periodicity—once or twice a year

  • Quick turnaround of results

  • Administration by independent third party

  • Inclusion of all patients in survey at small facilities: 1) patients expect to be included; 2) small numbers makes their inclusion essential for statistical reasons

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Ten Recommendations

  • Develop a standardized survey and involve the renal community

  • Initial survey development is for in-center hemodialysis, and focus is on quality improvement and public reporting. Assess need for translation into languages other than Spanish

  • Consider which items are and are not under control of facility (e.g., transportation)

  • Develop separate reports for patients and providers

  • Support efforts to determine how patients will make use of reports and the best methods of dissemination to them

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Ten Recommendations (continued)

  • Independent third party administration

  • Examine eligibility criteria, such as number of months

  • Look at mode effects, response rates, cost and case-mix issues in field test

  • Investigate number of patients per facility needed for accurate

  • Investigate proxy issues—how much and what kind of help patients

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CMS Accepted Report and Recommendations

  • Gave green light for survey construction and cognitive testing

  • Plans to create consumer and provider reports

  • Plans to take final survey and test its use for quality improvement in a few selected facilities for learning purposes

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Groundwork for ESRD CAHPS: The Feasibility Report

  • Beth Kosiak, Ph.D.

  • Center for Quality Improvement and Patient Safety, AHRQ