Measuring the Patients Experience with Care

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Measuring the Patients Experience with Care

• Disclosure Project Discussion Forum
• July 12, 2007
• Dale Shaller, MPA
• Shaller Consulting
• Managing Director, National CAHPS Benchmarking
  Database
• d.shaller_at_comcast.net
• 651-430-0759

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Presentation Outline

• What is the patient experience with care?
• Why is it important?
• How can it be measured?
• What is the unique contribution of CAHPS to
  measuring the patient experience?
• How is the nations health system performing on
  key CAHPS measures?

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IOMs 6 Aims for Improvement
Institute of Medicine. Crossing the Quality
Chasm. Washington, DC National Academy Press
2001.
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IOM Definition

• Health care that establishes a partnership among
  practitioners, patients, and their familiesto
  ensure that decisions respect patients wants,
  needs, and preferences and that patients have the
  education and support they need to make decisions
  and participate in their own care.

Institute of Medicine. Envisioning the National
Health Care Quality Report. Washington, DC
National Academy Press 2001.
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Picker Dimensions

• Respect for patient values, preferences
• Coordination and integration
• Information, communication, education
• Physical comfort
• Emotional support
• Involvement of family and friends
• Transition and continuity
• Access to care

Gerteis M, et al. Through the Patients Eyes.
San Francisco Jossey-Bass 1993.
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Patient experience is strongly correlated with
other key outcomes

• Health Outcomes
• Patient adherence
• Process of care measures
• Clinical outcomes
• Business Outcomes
• Patient loyalty
• Malpractice risk reduction
• Employee satisfaction
• Financial performance

Edgman-Levitan S., Shaller D. et al. The CAHPS
Improvement Guide. Boston Harvard Medical
School 2003.
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Patients Who Experience Worse Hospital CareAre
More Likely to Report Chest Pain 12 Months After
AMI
Percent of patients with symptoms
Fremont A, et al. Patient-Centered Processes of
Care and Long-Term Outcomes of Myocardial
Infarction. JGIM 16 (December 2001) 800-808.
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Approaches to measuring patient experience with
care

• Patient surveys
• Proprietary tools
• Public domain instruments (CAHPS)
• Focus groups and interviews
• Walkthroughs
• Mystery shopping participant observation by
  trained informants
• Web-based convenience reporting

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Caveat emptor example of consumer convenience
reporting
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The Evolution of CAHPS

• CAHPS Consumer Assessment of Healthcare
  Providers and Systems
• Most widely used survey tools for measuring the
  patients experience with care
• CAHPS Consortium initiated and funded by AHRQ
  since 1995
• CAHPS I Focus on health plans and consumer
  choice
• CAHPS II Expansion of survey instruments
• CAHPS III New focus on QI and reporting
  applications
• Current consortium members include AHRQ, CMS,
  AIR, RAND, Yale/Harvard, and Westat

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Expanding Suite of CAHPS Surveys
Facility Care
Ambulatory Care

• Health Plans
• Group Practices
• Individual Clinicians
• Behavioral Health Organizations (ECHO)
• Home Health

• Hospitals
• Dialysis Facilities
• Nursing Homes

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Common CAHPS Design Principles

• Include reports and ratings of experiences not
  satisfaction
• Standardization to enable valid comparisons
  (through CAHPS Database)
• Content based on evidence of what patients want
  to know and for which they are the best or only
  source of information
• Question items and survey protocols based on
  rigorous scientific development and testing, as
  well as stakeholder input

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Common CAHPS Design Principles (continued)

• A core set of question items with option to add
  from a bank of tested supplemental questions
• Special populations (e.g., chronic conditions,
  persons with mobility impairments)
• Quality improvement applications
• Focus on development of reports as well as survey
  instruments
• All CAHPS surveys and services are in the public
  domain

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CAHPS Health Plan Survey

• Over 138 million Americans are enrolled in health
  plans that are assessed using CAHPS
• Major users
• Federal purchasers CMS, OPM, DoD
• NCQA Health plan accreditation
• State Medicaid Agencies
• Health plans
• Employer coalitions (e.g., NBCH eValue8)

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Major Domains of CAHPSHealth Plan Survey 4.0

• Access getting needed care
• Access getting care quickly
• Doctor communication
• Health plan customer service, information, and
  paperwork
• Global ratings (overall care, health plan,
  personal doctor, specialist)

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National CAHPS Benchmarking Database. 2006 CAHPS
Health Plan Survey Chartbook. (October 2006)
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CAHPS Hospital Survey (H-CAHPS)

• Nations first standardized survey of inpatient
  experiences with care
• Endorsed by National Quality Forum in 2005
• Centers for Medicare and Medicaid (CMS)
• 2007 H-CAHPS reporting tied to hospital payment
  increases
• Public reporting in March 2008

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Dimensions Measured by H-CAHPS

• Composites
• Communication with doctors
• Communication with nurses
• Communications about medications
• Pain management
• Cleanliness and quiet of hospital environment
• Discharge information
• Overall rating
• Willingness to recommend

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2006 H-CAHPS Composite Results
National CAHPS Benchmarking Database. 2007 CAHPS
Hospital Survey Chartbook. (May 2007)
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CAHPS Clinician Group Survey

• Adopted by AQA and submitted for endorsement by
  NQF
• Adult, pediatric, and specialty versions
• Core composites
• Access Getting appointments and care when needed
• Doctor communication
• Office staff courtesy and helpfulness
• Many supplemental items
• Health promotion and education
• Shared decision making
• QI items
• Visit-specific questions

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Implementation Models for CAHPS Clinician Group
Survey

• Regional collaboratives
• BQI markets
• Aligning Forces markets
• Accreditation/certification
• American Board of Medical Specialties
• National health plan consortium
• CSS initiative
• Independent efforts
• Health plans
• Medical groups

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Public Reporting of Survey Measures

• Out of 211 report cards in AHRQs Report Card
  Compendium
• 113 include patient experience measures
• 69 health plan reports
• 20 medical group/clinic reports
• 19 hospital reports
• 3 nursing home reports
• 2 individual physician reports
• http//www.talkingquality.gov/compendium/index.htm
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