Presentation on theme: "Psychometric Properties of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Adult Visit Survey September 11, 2012."— Presentation transcript:
Psychometric Properties of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Adult Visit Survey September 11, 2012 Naomi Dyer, PhD, Joann Sorra, PhD, Scott Smith, PhD, Westat Paul Cleary, PhD, Yale Ron Hays, PhD, RAND
CAHPS is a multiyear initiative of AHRQ to support and promote the assessment of consumers’ experiences with health care Numerous CAHPS surveys have been created for different health care settings such as : Health Plan Surgical Care Home Health Care Hospital In-center Hemodialysis Nursing Home Clinician & Group Background
Westat, under contract with AHRQ, houses the database for Clinician and Group CAHPS (CG- CAHPS) and reports on these data Background
There are several CG-CAHPS Surveys: CG-CAHPS 12-month Survey (Adult and Child) CG-CAHPS 12 month Survey with Patient-Centered Medical Home CG-CAHPS Visit Survey (Adult and Child) CG-CAHPS Database is the newest component of the CAHPS Databases The CG-CAHPS Adult Visit Survey database received the most data in 2011 Background
The CG-CAHPS Visit surveys were created to allow patients to report on and evaluate their experiences during their most recent outpatient medical visit The 12 month versions ask about their experiences in the previous year Surveys and related material available at: http://cahps.ahrq.gov/clinician_group/ Background
Goal: Develop a survey to assess patients' experiences with medical groups and clinicians. Development of the Visit Survey began in 2008 Field testing in 2009 to compare with the 12-month survey version Results led to the Access to Care items in the survey reverting to a 12-month reference period rather than visit- specific Survey Development
CG-CAHPS Composites 3 composites 1. Access to Care (5 items) 2. Doctor Communication (6 items) 3. Courteous/Helpful Staff (2 items) 2 overall rating items 1. Overall Doctor Rating (11-point scale; 0 = “Worst doctor possible”, 10 = “Best doctor possible”) 2. Recommend the Doctor’s Office to family and friends (3-point scale; “No” to “Yes, definitely”) Various socio-demographics including overall health, age, gender, and education
Access to Care Composite All 5 items reference a 12-month period 4-point scale (1 = Never, 2 = Sometimes, 3 = Usually, 4 =Always)
Access to Care Composite In the last 12 months, How often did you get an appointment for care you needed right away as soon as you needed? How often did you get an appointment for routine care as soon as you needed? When you phoned this doctor’s office during regular office hours, how often did you get an answer to your medical question that same day? When you phoned this doctor’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? How often did you see this doctor within 15 minutes of your appointment time?
Doctor Communication Composite All six items reference the most recent office visit 3-point scale (1 = Yes, definitely; 2 = Yes, somewhat; 3 = No) During your most recent visit, did this doctor… Explain things in a way that was easy to understand? Listen carefully to you? Give you easy to understand information about your health questions or concerns? Seem to know the important information about your medical history? Show respect for what you had to say?
Courteous/Helpful Staff Composite Both items reference the office visit 3-point scale (1 = Yes, definitely; 2 = Yes, somewhat; 3 = No) During your most recent visit, were clerks and receptionists at this doctor’s office… As helpful as you thought they should be? Treat you with courtesy and respect?
CG-CAHPS Analysis Dataset Adult Visit Survey Data from the CG-CAHPS Comparative Database 103,442 responses 469 practice sites There were 5 screener questions that determined if the composite item was to be answered by respondents 4 screener questions for Access to Care 1 screen question Doctor Communication Only non-missing data for the composite items were included in the analysis
CG-CAHPS Analysis Dataset 93% of respondents did not phone their doctor after regular hours Because of the high percentage of skips, “How often did you get an appointment for care you needed right away as soon as you needed?” was dropped from analysis Remaining 4 Access to Care composite items had responses between 46% to 98% of respondents Final CG-CAHPS Analysis Dataset 450 practice sites 21,318 responses
Characteristics of Analysis Dataset All respondents received paper/mail surveys 89% of sites were Family Practice or Internal Medicine 69% of sites were owned by a hospital or integrated delivery system 67% of respondents were female; 81% were 45 years or older
Psychometric Analyses and Criterion Individual and Multilevel Confirmatory Factor Analysis (CFA) Factor loadings above 0.40 Acceptable model fit indices CFI > 0.95 RMSEA < 0.06 SRMR < 0.08 (Individual, Between- and Within-) Individual Internal Consistency Reliability Analysis Cronbach’s α ≥ 0.70
Psychometric Analyses and Criterion Practice Site Reliability Analysis Reliability ≥ 0.70 Examined reliability by practice size categories 1 clinician 2 to 3 clinicians 4-9 clinicians 10-13 clinicians 14-19 clinicians 20 or more clinicians Correlation analysis among the composites and global ratings Individual and practice site levels
Individual Level CFA Results All items within composites had individual factor loadings above 0.40 with average loadings of Access to Care: 0.68 Doctor Communication: 0.76 Courteous/Helpful Staff: 0.86 All model fit indices met criteria CFI: 0.97 RMSEA: 0.05 SRMR: 0.04
Multilevel CFA Results All items at practice site level had factor loadings above 0.40 Between site factor loadings range: 0.59 to 0.99 Within site factor loadings rage: 0.45 to 0.99 All model fit indices met criteria except between- practice site SRMR CFI: 0.97 RMSEA: 0.03 Between SRMR: 0.10 Within SRMR: 0.05
Internal Consistency Reliability All items at individual level had Cronbach’s alpha above 0.70 Access to Care α = 0.77 Doctor Communication α = 0.89 Courteous/Helpful Staff α = 0.85
Practice Site Reliability Practice site reliability estimate were acceptable for all site with at least 4 clinicians For a site with 1 clinician Only Access to Care had reliability above 0.70 For a site with 2-3 clinicians Access to Care and Courteous/Helpful Staff had reliability above 0.70 The average number of respondents for 1 clinician and 2-3 clinicians was less than 100 Smaller sites need more respondents per practice to increase reliability to acceptable levels
Individual Correlations Composites and Global Ratings 1234 1. Access to Care 2. Doctor Communication 0.35 3. Courteous/Helpful Staff 0.290.25 4. Overall Doctor Rating 0.390.520.22 5. Recommend Doctor’s Office 0.340.520.290.47 All correlations were significant (p < 0.05) Strongest correlation was between Doctor Communication and Overall Global Rating Items
Practice Site Level Correlations All correlations were significant (p < 0.05) Composites and Global Ratings 1234 1. Access to Care 2. Doctor Communication 0.45 3. Courteous/Helpful Staff 0.570.41 4. Overall Doctor Rating 0.420.750.34 5. Recommend Doctor’s Office 0.520.760.430.76 Strongest correlation was between Doctor Communication and Recommend Doctor’s Office
Summary Overall, both the individual level and multilevel confirmatory factor analysis results provided support for the survey’s three composites The CG-CAHPS composites have acceptable individual-level internal consistency reliability The reliability remains acceptable across sites with four to twenty or more clinicians