Groundwork for ESRD CAHPS: The Feasibility Report

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Groundwork for ESRD CAHPS The Feasibility Report

• Beth Kosiak, Ph.D.
• Center for Quality Improvement and
  Patient Safety, AHRQ

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CMS to AHRQCan One Patient Survey Serve Two
Purposes?

• CMS urged by IG, GAO, MedPAC, others to field a
  patient survey and publicly report results
• CMS has been pursuing a quality agenda that
  includes both public reporting and internal
  quality improvement
• Many facilities administer their own patient
  surveys for quality improvement and CMS wants to
  encourage such activity

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Answer Maybe

• Unlike other populations for which CAHPS surveys
  have been developed, in-center hemodialysis
  patients have a lot of experience with care, lots
  of observations to draw upon
• This enables them to answer a broader range of
  questions with greater specificity e.g., if
  needles sticks are painful, if the center is
  usually clean, if staff take precautions to
  prevent infection
• These kinds of questions are interesting both to
  patients and facilities

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Background Research to Investigate the Question

• Comprehensive literature review of patient
  surveys conducted, characteristics of the
  population relevant to survey administration
  (e.g., literacy levels, cognitive impairment,
  etc.)
• Focus groups with patients and their families
• Focus groups with nephrologists
• Interviews with facility administrators and
  Network executives
• Meeting with TEP to get input on content of
  survey (TEP composed of representatives from
  facilities, Networks, research, provider, and
  patient advocacy communities

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Major Findings (Purpose and Use of Survey)

• Strong to moderate support for standardized
  survey, but concerns about losing valuable
  information from current surveys (especially
  since they are often a vehicle for communication
  with patients), burden and cost
• Patients and professionals agree that if a
  patient survey is administered, improvement of
  care should occur
• Professionals do not think comparative
  information will be usable for consumer choice
  but patients say they might switch to a higher
  rated facility

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Major Findings (Domains)

• Communication
• Education
• Concern and helpfulness of staff
• Patient (and family) involvement in care
• Coordination of care
• Patient perception of staff proficiency
• Patient safety
• Facility amenities and physical environment
• Access and convenience of care
• Handling of grievances and complaints
• Interpersonal relationships in the dialysis
  center

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Major Findings (Methods and Survey Administration)

• Site of survey administration (in the center, at
  home)
• Low literacy levels, fatigue, cognitive
  impairment, poor vision
• Periodicityonce or twice a year
• Quick turnaround of results
• Administration by independent third party
• Inclusion of all patients in survey at small
  facilities 1) patients expect to be included 2)
  small numbers makes their inclusion essential for
  statistical reasons

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Ten Recommendations

• Develop a standardized survey and involve the
  renal community
• Initial survey development is for in-center
  hemodialysis, and focus is on quality
  improvement and public reporting. Assess need for
  translation into languages other than Spanish
• Consider which items are and are not under
  control of facility (e.g., transportation)
• Develop separate reports for patients and
  providers
• Support efforts to determine how patients will
  make use of reports and the best methods of
  dissemination to them

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Ten Recommendations (continued)

• Independent third party administration
• Examine eligibility criteria, such as number of
  months
• Look at mode effects, response rates, cost and
  case-mix issues in field test
• Investigate number of patients per facility
  needed for accurate
• Investigate proxy issueshow much and what kind
  of help patients

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CMS Accepted Report and Recommendations

• Gave green light for survey construction and
  cognitive testing
• Plans to create consumer and provider reports
• Plans to take final survey and test its use for
  quality improvement in a few selected facilities
  for learning purposes

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Groundwork for ESRD CAHPS The Feasibility Report

• Beth Kosiak, Ph.D.
• Center for Quality Improvement and Patient
  Safety, AHRQ

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