The CAHPS Health Literacy Item Set Beverly Weidmer, RAND Corporation AHRQ 2009 Annual Conference Research to Reform: Achieving Health System Change Bethesda, Maryland September 15, 2009

Acknowledgments Funding for this project was provided by the Agency for Healthcare Policy and Research Our thanks go to the stakeholders who provided input on the content of the item set Our thanks also go to Affinity Health Plan and the University of Mississippi Medical Center for participating in the field test of the item set and to DataStat, Inc., our data collection partner.

In memoriam: Charles “Chuck” Darby “Founding Father” of CAHPS, former CAHPS Project Officer, mentor, colleague, cherished friend

What is CAHPS? CAHPS: Consumer Assessment of Health Providers and Systems Program funded by the Agency for Healthcare Research and Quality (AHRQ) Aim is to produce a set of standardized, evidence-based surveys for assessing patients’ experiences with the health care system

CAHPS Family of Surveys Facility level surveys (hospitals, dialysis facilities, nursing homes) Ambulatory level surveys (Health Plan, Clinician and Group, Dental Plan, etc.) Supplemental item sets on special topics (health literacy, cultural competence, chronic conditions, mobility impairment, etc.) Publicly available in both English and Spanish

CAHPS Health Literacy Item Set Designed to measure patients’ perspective on how well health information is communicated to them by healthcare professionals Designed as a supplemental item set for the CAHPS Clinician and Group Survey Developed by CAHPS grantees under the leadership of RAND

Development and testing Adapted from validated measures that are publicly available Reflects input from health literacy stakeholders Validated via cognitive interviews and a field test conducted by mail with phone follow up

Purpose Provide data that can be used to: Identify areas for quality improvement at the clinician and group level Evaluate QI activities designed to improve communication with patients Report quality data back to physicians Provide information to consumers

Content Topics include: Communication with doctors and nurses Communication about health problems/concerns Communication about medications Communication about tests Communication about forms All items linked to AMA Foundation’s: “Health literacy and patient safety: help patients understand.” (Refer to the QI Strategies Crosswalk in the CAHPS C&G Survey and Reporting Kit 2008).

Overview Twenty-nine items in total 2 composites measures –General Communication (5 items) –Communication about medications (7 items) Users are encouraged to use composite measures but may also use individual items if they are interested in a specific topic

General Communication Composite HL9. In the last 12 months, how often did this doctor give you all the information you wanted about your health? HL12. In the last 12 months, how often did this doctor give you easy to understand instructions about what to do to take care of this illness or health condition? HL17. In the last 12 months, how often did you feel this doctor really cared about you as a person? HL13. In the last 12 months, how often did this doctor ask you to describe how you were going to follow these instructions? HL25. In the last 12 months, how often were the results of your blood test, x-ray or other test easy to understand?

Communication About Medications Composite HL18. In the last 12 months, did this doctor prescribe any new medicines or change how much medicine you should take? HL19. In the last 12 months, how often did this doctor give you easy to understand instructions about how to take your medicines? HL20. In the last 12 months, did this doctor explain the possible side effects of your medicines?

Communication About Medications Composite--continued HL21. In the last 12 months, how often did this doctor explain the possible side effects of your medicines in a way that was easy to understand? HL22. In the last 12 months, other than a prescription, did this doctor give you written information or write down information about how to take your medicines?

Communication About Medications Composite--continued HL23. In the last 12 months, how often was the written information you were given easy to understand? HL24. In the last 12 months, how often did this doctor suggest ways to help you remember to take your medicines?

Next steps… Make items publicly available ( Expected release date: Fall 2009 Develop HCAHPS Health Literacy Item Set

HCAHPS Health Literacy Item Set Health Literacy supplemental item set for HCAHPS currently under development Expected release date in Spring 2010 Domains include: –Patient-provider communication –Discharge planning –Communication about medications –Communication about test results –Communication about forms

Questions? Contact: Beverly Weidmer RAND Corporation 1776 Main St. Santa Monica, CA (310) , ext