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Developing CAHPS for People with Mobility Impairments

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Why we decided to create a CAHPS for people with mobility impairments ... 3-day doctor training course facilitated by American Academy on Physician and Patient (AAPP) ... – PowerPoint PPT presentation

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Title: Developing CAHPS for People with Mobility Impairments


1
Developing CAHPS for People with Mobility
Impairments
  • June 8, 2005
  • Marybeth Farquhar
  • Sue Palsbo

2
Presentation Overview
  • Purpose and History
  • Structure (core questions and supplements)
  • How it is used
  • Why we decided to create a CAHPS for people with
    mobility impairments
  • Steps to create a CAHPS survey
  • Progress to date on CAHPS-PWMI
  • Example How CAHPS helped a physician group
    practice improve quality
  • Questions and Answers

3
CAHPS Overall Goal
  • To provide carefully tested, standardized survey
    questionnaires and reports
  • Used to report meaningful, reliable information
    from patients rating their health care
    experiences.

4
CAHPS Principles
  • Reports and ratings of experiences -- not just
    satisfaction
  • Standardization to enable valid comparisons
  • Evidence basis for design, protocols, and
    language
  • All CAHPS products and services in public domain

5
How Survey Reports are Used
  • Consumers to choose a health plan
  • Purchasers to choose health plans to offer to
    employees or beneficiaries
  • Health insurers to improve administrative
    operations
  • Facilities and HMOs to improve health care
    operations

6
Example Maryland Medicaid Report Card (2004)
7
How Maryland State Collected the Information
8
A Growing Family of Surveys
CAHPS Family
  • Ambulatory Level
  • Health Plans
  • Group Practices
  • Behavioral Health Organizations (ECHO)
  • Individual Clinicians
  • Facility Level
  • Hospitals
  • Dialysis Facilities
  • Nursing Homes

In development
9
Many Inputs Into CAHPS Development Process
Literature and existing instruments
Call for measures
Field testing
CAHPS Surveys
  • Cognitive interviews

Focus groups
Public and stakeholder input
10
CAHPS Development
  • Needs Assessment
  • Conduct Literature Review
  • Gather Stakeholder Input
  • Develop test questionnaire
  • Develop test sampling protocol
  • Develop test data collection protocol
  • Develop test reports
  • Develop analysis program
  • Develop QI program
  • Translate tools

11
CAHPS Reporting Maintenance
  • Promote use with potential sponsors
  • Create database
  • Maintain database
  • Evaluate tool use
  • Provide technical assistance
  • Gather user input
  • Continue research to refine tools
  • Maintain, update refine tools
  • Disseminate research

12
Rationale for CAHPS PWMI Development
  • Persons with physical disabilities have a
    thinner margin of health.
  • Stakeholders need to reduce disparities in
    quality and access, so care is equal.
  • More persons with mobility impairments are being
    offered a choice of health plans.

13
CAHPS- PWMI Consortium A Public-Private
Research Team
AHRQ
Harvard

CDC
Federal Agencies
  • Grantee Teams

CAHPS II Consortium
AIR
NIDRR
RAND
Westat
National Rehabilitation Hospital GMU Center for
Health Policy, Research Ethics
14
Purpose Goals
  • To develop screening questions that identify
    adults with mobility impairments
  • To develop, pilot test, and evaluate the
    psychometric properties of questions that ask
    about the quality of their health care
    experiences.

15
Progress to Date
  • Developed an 11-item screener to identify
    respondents with mobility impairments
  • Cognitive testing and revisions
  • Field tested as part of the Massachusetts Health
    Medicaid Study and DRRP on Medicaid Quality
    Indicators for People with Disabilities
  • Analysis of the field test results (in progress)
  • Literature review (in progress)
  • Call for Measures (FRN and this Web cast!)
  • TEP

16
Planned Tasks for Next 6 Months
  • Work with the TEP
  • Identify content domains
  • Develop a draft survey
  • Cognitive testing of questions and sequence
  • Finalize tool for field testing in 2006

17
Ambulatory Surveys Cover Seven Domains
  • Doctor Communication

Customer Service
Access
Office Staff Courtesy, Helpfulness and Respect
Shared Decision-Making
Coordination/Integration
Health Promotion and Education
18
Criteria for Selecting Domains
  • Important for reaching, maintaining a high level
    of quality
  • Important to consumers in selecting health care
  • Aspects of care for which consumers are best or
    only judge

19
From Domains to Topics to Items An Example
  • Domain Access
  • Topics
  • Getting needed care
  • After-hours care
  • Utilization
  • Getting care quickly
  • Wait time
  • Special services
  • Prescriptions
  • Items
  • Problems seeing a specialist
  • Problems getting care, tests, or treatment
  • Etc.

20
How Physicians Might Use a CAHPS-PWMI Survey
21
Limitations of the Health Plan Survey
  • Plan-level data collection too imprecise for
    practice level improvements members vs.
    patients, large samples
  • Surveys need to focus on the processes that are
    most relevant to consumers/patients at the plan
    level and the practice level, e.g. customer
    service for a plan, office staff interactions and
    the clinical experience for a practice.

22
Why a Survey for Clinicians Groups?
  • It is the right unit of analysis for QI
  • Consumers have more choice of practices than they
    do of plans
  • Data can be actionable for an individual practice
    or site
  • Plans/payers can identify benchmark performers
    more precisely.

23
Why a Survey for Clinicians Groups?
  • Data collection at the practice/ provider level
    survey helps support multiple uses of the same
    data
  • Maintenance of certification for doctors, ABMS
    activities
  • External use by plans/ payers
  • CMS Doctor Office Quality project

24
CAHPS Clinician Group Survey Content Areas
  • Doctor Communication
  • Shared Decision-Making
  • Health Promotion and Education
  • Coordination/Integration
  • Other Clinicians in the Practice (Care Team)
  • Access
  • Office Staff

Visit Module

25
Sample Size Requirements for Varying
Physician-Level Reliability Thresholds
26
Stillwater Medical Group (SMG) Baseline Survey
Results (n164)
Access Getting Needed Care
Office Functioning Scheduling Visit Flow
Communication Interpersonal Care
Integration
Percentile Rank Adjusted
Preventive Care
Priority Improvements
Correlation to Measure of Willingness to Recommend
1/9/04
27
Stillwater Medical Group Results of the
Intervention
  • Priority aim
  • Improve doctor communication scores
  • Intervention
  • 3-day doctor training course facilitated by
    American Academy on Physician and Patient (AAPP)
  • 56 of 58 doctors attended in May 04
  • Results
  • Notable short-term improvement in question scores
    related to doctor communication
  • Mixed results in question scores over the longer
    term
  • Verbal support for Patient-centered care and
    need for improvement to help sustain and increase
    our business

28
Stillwater Medical Group What They Learned
  • Everyone wants to provide good service, but they
    need to constantly work on improving.
  • Their patients really like them and once they
    start to come here they keep coming back.
  • Data is a powerful motivator, but it needs to be
    individualized to really impact providers
  • They raised awareness about this issue.

29
Harvard Vanguards Interventions to Improve
Patients Experiences
  • Improve visit-based continuity by increasing the
    percentage of the time that patients see their
    own primary care physician when they come to the
    office for care.
  • Improve visibility of clinical team by carefully
    structuring practices into teams with staff known
    to the patients.

30
HVMA Cost of Improvement Offset by Benefits
  • Costs
  • Survey costs
  • Analysis costs
  • Investment in practice change
  • Benefits
  • Better retention of patients
  • Better retention of more satisfied staff
  • Practice growth

31
Harvard Vanguard Medical Associates What They
Learned
  • They learned a lot about what their patients
    thought of their experience with them.
  • They learned that their staff was also worried
    about the practice, and frustrated that their
    patients werent more satisfied.
  • They learned how hard it is to change practice
    infrastructure and culture.

32
Questions Answers!
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