1. The John D. Stoeckle Center for Primary Care Innovation CAHPS Driven Quality Improvement: Primary Care Susan Edgman-Levitan,PA Executive Director Stoeckle Center for Primary Care Innovation Massachusetts General Hospital Massachusetts General Hospital Co-PI, Yale/Harvard CAHPS Team

2. The John D. Stoeckle Center for Primary Care Innovation IFCC Core Concepts of Patient and Family- Centered Care Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making.Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making.

3. The John D. Stoeckle Center for Primary Care Innovation IFCC Core Concepts of Patient and Family- Centered Care Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose. Collaboration. Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation; in facility design; and in professional education, as well as in the delivery of care.Collaboration. Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation; in facility design; and in professional education, as well as in the delivery of care.

4. The John D. Stoeckle Center for Primary Care Innovation Dimensions of Patient and Family-Centered Care In addition to safe and technically excellent care, patients and families identify the following specific dimensions as the most critical aspects of the ambulatory care experience:In addition to safe and technically excellent care, patients and families identify the following specific dimensions as the most critical aspects of the ambulatory care experience: Access;Access; Respect for patients’ values and preferences;Respect for patients’ values and preferences; Coordination of care;Coordination of care; Information, communication, and education;Information, communication, and education; Emotional support;Emotional support; Involvement of friends and family;Involvement of friends and family;

5. The John D. Stoeckle Center for Primary Care Innovation Clinician-Group CAHPS and Patient and Family- Centered Care Getting Appointments and Health Care When NeededGetting Appointments and Health Care When Needed Access to information and appointmentsAccess to information and appointments Waiting times in the office and exam roomWaiting times in the office and exam room How Well Doctors CommunicateHow Well Doctors Communicate Respect for patient preferencesRespect for patient preferences Clear and understandable information about diagnosis, treatments, and medicationsClear and understandable information about diagnosis, treatments, and medications Listening and empathyListening and empathy Courteous and Helpful Office StaffCourteous and Helpful Office Staff Respectful, helpful, and courteous office staffRespectful, helpful, and courteous office staff Overall RatingOverall Rating

6. The John D. Stoeckle Center for Primary Care Innovation The CAHPS ® Improvement Guide A resource manual for health plans and medical groups seeking to improve their CAHPS ® scoresA resource manual for health plans and medical groups seeking to improve their CAHPS ® scores Funded by CMS (Medicare) and developed by Harvard Medical School CAHPS ® TeamFunded by CMS (Medicare) and developed by Harvard Medical School CAHPS ® Team Over 2 dozen strategies mapped to CAHPS ® core questionsOver 2 dozen strategies mapped to CAHPS ® core questions

7. The John D. Stoeckle Center for Primary Care Innovation Plan Strategy - Create team (if needed) - Establish/confirm goals - Investigate potential interventions (see Section 4) Develop and Test Strategy - Select measures to monitor progress - - Develop changes using selected intervention - - Conduct small tests of change - - Adapt changes to organizational context - Identify and deal with barriers Monitor Strategy - Implement changes and hold the gains - Evaluate progress against criteria Reassess & Respond - Use CAHPS data to assess what worked, what didn’t - Spread successful innovations Section 4. Ideas for Improving Experiences with Care Section 2. Identifying Opportunities to Improve Getting needed care Getting care quickly Doctors communicate well Customer service Home health & preventive services For each opportunity: Section 1. Setting the Stage: An Infrastructure that Supports Improved Performance Section 3. Implementing the CAHPS Improvement Cycle A Guide to the CAHPS QI Guidebook Claims Processing

8. The John D. Stoeckle Center for Primary Care Innovation CAHPS and Quality Improvement CAHPS III:CAHPS III: Refining QI model for implementing patient and family-centered careRefining QI model for implementing patient and family-centered care Creation of a meta-model to guide practice redesign and implementation of patient and family-centered care;Creation of a meta-model to guide practice redesign and implementation of patient and family-centered care; Updating of CAHPS Improvement Guide to link with new Health Plan and Clinician-Group CAHPS surveysUpdating of CAHPS Improvement Guide to link with new Health Plan and Clinician-Group CAHPS surveys Conversion to a web-based document to improve access and linkages to CAHPS reports.Conversion to a web-based document to improve access and linkages to CAHPS reports.

9. The John D. Stoeckle Center for Primary Care Innovation Factors That May Contribute to Measurable and Sustained Improvement Leadership is committed and engagedLeadership is committed and engaged Strategic goals are aimed at organizational transformationStrategic goals are aimed at organizational transformation Focusing on involving patients and families in redesign and improvement activities.Focusing on involving patients and families in redesign and improvement activities. Focus on employee, clinician, and patient satisfaction.Focus on employee, clinician, and patient satisfaction. Internal communication and action are aligned with strategic goalsInternal communication and action are aligned with strategic goals Motivation through external rewards and incentivesMotivation through external rewards and incentives

10. The John D. Stoeckle Center for Primary Care Innovation Strategies for Clinician-Group CAHPS QI Link patient experience of care data to internal incentive programsLink patient experience of care data to internal incentive programs Link patient experience of care data to external P4P programsLink patient experience of care data to external P4P programs data to P4P and other incentivesdata to P4P and other incentives Collect and report physician-level dataCollect and report physician-level data

11. The John D. Stoeckle Center for Primary Care Innovation Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger. Franklin P. Jones

12. The John D. Stoeckle Center for Primary Care Innovation Strategies for Clinician-Group CAHPS QI Perform analyses that address “50 ways to deny the data”Perform analyses that address “50 ways to deny the data” Staff surveysStaff surveys Educational efforts at multiple levels of the organizationEducational efforts at multiple levels of the organization Link to other performance dataLink to other performance data Panel sizePanel size Practice designPractice design HEDIS dataHEDIS data

13. The John D. Stoeckle Center for Primary Care Innovation

14. The John D. Stoeckle Center for Primary Care Innovation