CAHPS Overview Clinician & Group Surveys: Practical Options for Implementation and Use AHRQ ANNUAL MEETING SEPTEMBER 18, 2011 Christine Crofton, PhD CAHPS Project Officer

2 Overview of the afternoon Overview of CAHPS Surveys & Design Principles CAHPS Clinician & Group Survey: An Introduction to the 2.0 Version Implementing CAHPS C&G Surveys: Strategies and Opportunities

3 Overview, cont’d Assessing CAHPS C&G Survey Results: What the CAHPS Databases Can Do for You Improving Patient Experience in Primary Care: Resources & Examples including the CAHPS Survey for the Patient-Centered Medical Home

4 Overview, cont’d Reporting on Patients’ Experiences with Primary Care: Resources & Examples

5 CAHPS Integrated system of products and strategies Obtain assessments from consumers of the quality of care that they receive in different settings which Inform selection decisions Identify areas where providers and organizations can improve their services Provide quality information to care providers and other audiences

6 The CAHPS Team Grantees, currently RAND and Yale User Network Contractor, currently Westat AHRQ staff Stakeholders from other government agencies, such as CMS, NIDDR, CDC Stakeholders from other private organizations, non-profits and advocacy groups

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

8 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 –Patient Centered Medical Home

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

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

11 CAHPS Supplemental Item Sets Children with Chronic Conditions People with Mobility Impairments Health Literacy Cultural Competence Health Information Technology Additional item sets for: Health Plan Survey Clinician & Group Survey

CAHPS Surveys 12 CAHPS Core Questionnair e Items Supplemental Items CAHPS Survey

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 Standardization: Recommended Data Collection Protocols Dual mode data collection: 1)Advance notification letter 2)1 st mailing of questionnaire packet 3)Reminder post card 4)Replacement mailing of questionnaire packet 5)Offer telephone interviews to mail nonresponders

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

24 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

25 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

26 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

27 Obtaining technical assistance Free! –Products Surveys and Instructions ( –CAHPS Technical assistance Help Line ( ) Help