Assessing Patient-Centered Medical Homes from the Patient Perspective: Developing the CAHPS ® Clinician & Group PCMH Survey Patricia Gallagher, PhD Center for Survey Research University of Massachusetts Boston Yale CAHPS Team

Current CAHPS Consortium AHRQ Grantees RAND Yale CAHPS User Network Westat Other Government and Private Stakeholders CMS NCQA 2

3 The CAHPS Family of Surveys Family of surveys: comprehensive and evolving Patients evaluate their experiences with ambulatory and facility health care All surveys are in the public domain CAHPS surveys ask about experiences with …  AMBULATORY CARE  Clinicians and Medical Groups  Health plans  Behavioral health services  Dental plans  FACILITIES  Hospitals  Nursing homes  Dialysis facilities

Collaboration with NCQA Increasing attention to patient engagement was a key driver in NCQA’s update of its PCMH recognition program. NCQA conducted public comment to identify priorities for a PCMH survey Then worked with the CAHPS team to develop and test items 4

CAHPS Design Principles  Emphasis on patients –What patients value with respect to the setting of care –Aspects of care for which patients are the best or only source of information –Extensive testing with patients and families  Reports and ratings about experiences  Standardization –Questionnaires, data collection protocols, analysis, reporting  Multiple versions for diverse populations –Adult; Child; English & Spanish versions  All CAHPS surveys and products are in the public domain 5

CAHPS Clinician & Group Survey: Patient-Centered Medical Home Version 6 CAHPS Clinician & Group Core Questionnaire* CAHPS PCMH Item Set CAHPS C&G PCMH Survey * NQF endorsed

Overview of CAHPS C&G PCMH Surveys Expanded CAHPS C&G PCMH Surveys are appropriate for all primary care practices (PCMH and non-PCMH) Versions for Adult and Pediatric Populations Appropriate for general population 12-month “look-back” period Referent is “provider” or “provider’s office” 7

NCQA’s PCMH 2011 Recognition Program More emphasis on patient-centered care Use of patient surveys Additional credit for using the CAHPS C&G PCMH Survey NCQA also plans a separate distinction in Patient Experiences Reporting for PCMH practices that report the results of patient experiences surveys 8

Overview of Development Process Technical Expert Panels (CAHPS and NCQA) Literature review Focus group feedback Cognitive testing (English and Spanish) Draft survey for Field Test NCQA Field Test (English) Psychometric analysis & Instrument refinement NCQA Public Comment Period Instrument Refinement Public Release of C&G Survey with PCMH questions 9

CAHPS C&G PCMH Survey Domains Clinician & Group - Access to Care - Communication - Office Staff PCMH - Comprehensiveness - Self Management Support - Shared Decision Making - Coordination of Care - Information about Care and Appointments 10

Example of Item Development Issues #1 PCMH Shared Decision Making Items –Screen for eligible respondents –Provider talked about reasons to take a medicine –Provider talked about reasons not to take a medicine –Provider asked what you thought was best for you regarding medicine Notes: –Only in Adult questionnaire. Taking prescription meds more rare in Pediatric population; SDM items included as pediatric supplemental set –Tested Shared Decision Making related to surgery but incidence was too low 11

Example of Item Development Issues #2 PCMH Self Management Support Items –Work with you to set specific goals for your health –Ask you if there are things that make it hard for you to take care of your health Notes –PCMH Items are designed for a general population –Supplemental Items in development for population with chronic conditions 12

CAHPS C&G PCMH Survey Reporting: C&G Core + PCMH Measures (Slide 1) CAHPS C&G Core: Composite Measures - Getting Timely Appointments, Care & Information (5 items) - How Well Providers Communicate With Patients (6 items) - Helpful, Courteous Office Staff (2 items) Child Survey Only: - Provider’s attention to your child’s growth & development (6) - Provider’s advice on keeping your child safe & healthy (5) Provider Rating {PLUS …} 13

CAHPS C&G PCMH Survey Reporting: C&G Core + PCMH Measures (Slide 2) PCMH Composite Measures –Providers pay attention to your mental or emotional health (Adult only; 3 items) –Providers support you in taking care of your own health (2 items) –Providers discuss medication decisions (Adult only; 3 items) 14

Public Release The expanded Clinician & Group 12-Month Survey with PCMH Items will soon be available for download on the new CAHPS website: Measuring Patients’ Experiences with Medical Homes Using the CAHPS Patient-Centered Medical Home (PCMH) Item Set: o A free webcast sponsored by the CAHPS User Network o Thurs, November 3, 2011, 2-3:30 ET 15

CAHPS User Network Resources 16 Users of CAHPS survey products and results have access to free resources: CAHPS Clinician & Group Surveys and Instructions CAHPS Database Current information about CAHPS products Educational conferences and webcasts One-on-one technical assistance

CAHPS User Network Visit the CAHPS Website: Call the Help Line Write the Help Line: 17

Thank you! 18

Reference Slides 19

Recommended Modes of Data Collection Mail Questionnaires only Telephone Interviews only Mixed Mode Administration –Mail + Telephone – + Mail/Telephone 20

Overview of Adult Instrument 21 Domain C&G Core Item Count PCMH Item Count C&G Core + PCMH Item Count Access to Care 9312 Communication 718 Comprehensiveness 033 Office Staff 202 Self Management Support 022 Shared Decision Making 044 Coordination of Care 246 Information about Care & Appointments 033 Overall Rating 101 Eligibility 404 Demographics 909 Total Item Count342154

Overview of Pediatric Instrument 22 Domain C&G Core Item Count PCMH Item Count C&G Core + PCMH Item Count Access to Care 9312 Communication 140 Comprehensiveness 110 Office Staff 202 Self Management Support 022 Coordination of Care 246 Information about Care & Appointments 033 Overall Rating 101 Eligibility 404 Demographics 120 Total Item Count551267

Overview of Survey Instruments Access to Care C&G Core –Got appointment for urgent care as soon as needed –Got appointment for check-up or routine care as soon as needed –Got answer to medical question the same day you phoned provider's office –Got answer to medical question as soon as you needed when phoned provider's office after hours –Saw provider within 15 minutes of appointment time PCMH Supplemental Items –Got needed care on evenings, weekends, or holidays –Days you had to wait for an appointment for urgent care 23

Overview of Survey Instruments Communication C&G Core –Provider explained things in a way that was easy to understand –Provider listened carefully –Provider gave easy to understand instructions about taking care of health problems or concerns –Provider seemed to know important information about your medical history –Provider respected what you had to say –Provider spent enough time with you PCMH Supplemental Items –Provider knew you as a person (Adult only) 24

Overview of Survey Instruments Communication Pediatric only items C&G Core –Provider explained things in a way that was easy for child to understand –Provider listened carefully to child –Provider gave you enough information about what was discussed with child when you were not there –Provider gave you enough information about needed follow-up for child's care 25

Overview of Survey Instruments Comprehensiveness Growth and Development - Pediatric only items C&G Core –Talked about child's learning ability –Talked about behaviors that are normal for child at this age –Talked about how your child's body is growing –Talked about child's moods and emotions –Talked about how child gets along with others 26

Overview of Survey Instruments Comprehensiveness Keeping Child Safe and Healthy - Pediatric only items C&G Core –Talked about things to do to keep child from getting injured –Given information about keeping child from getting injured –Talked about how much time child spends in front of a computer and TV –Talked about food your child eats –Talked about exercise your child gets –Talked about if there were problems in household that might affect child 27

Overview of Survey Instruments Comprehensiveness Behavioral - Adult only items PCMH Items –Talked about personal or family problem/alcohol or drug use –Talked about worry and stress in your life –Talked about feeling sad or depressed 28

Overview of Survey Instruments Office Staff C&G Core –Clerks and receptionists at this office were as helpful as you though they should be –Clerks and receptionists at this office treated you with courtesy and respect 29

Overview of Survey Instruments Self Management Support PCMH Items –Work with you to set specific goals for your health –Ask you if there are things that make it hard for you to take care of your health Notes –PCMH Items are designed for a general population –Supplemental Items in development for population with chronic conditions 30

Overview of Survey Instruments Shared Decision Making Adult only items PCMH Items –Provider talked about reasons to take a medicine –Provider talked about reasons not to take a medicine –Provider asked what you thought was best for you regarding medicine Notes –Taking prescription meds more rare in Pediatric population; items included as pediatric supplemental –Tested Shared Decision Making related to surgery but incidence was too low 31

Overview of Survey Instruments Coordination of Care C&G Core –Provider's office followed up to give you results of blood test, x- ray, or other test PCMH Items –Provider seemed informed and up-to-date about care you got from specialists –Talked with you about your prescriptions 32

Overview of Survey Instruments Information about Care & Appointments PCMH Items –Got information about what to do if you needed care on evenings, weekends, or holidays –Received reminders between visits 33