Christine Crofton, PhD CAHPS Project Officer

1. CAHPS Overview Clinician & Group Surveys: Practical Options for Implementation and UseAHRQ ANNUAL MEETINGSEPTEMBER 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

12. CAHPS Surveys

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: • Advance notification letter • 1st mailing of questionnaire packet • Reminder post card • Replacement mailing of questionnaire packet • 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 (http://www.cahps.ahrq.gov) • CAHPS Technical assistance • Help Line (1.800.492.9261) • E-mail Help (cahps1@ahrq.gov)