Title: Developing CAHPS for People with Mobility Impairments
1Developing CAHPS for People with Mobility
Impairments
- June 8, 2005
- Marybeth Farquhar
- Sue Palsbo
2Presentation 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
3CAHPS Overall Goal
- To provide carefully tested, standardized survey
questionnaires and reports - Used to report meaningful, reliable information
from patients rating their health care
experiences.
4CAHPS 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
5How 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
6Example Maryland Medicaid Report Card (2004)
7How Maryland State Collected the Information
8A 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
9Many Inputs Into CAHPS Development Process
Literature and existing instruments
Call for measures
Field testing
CAHPS Surveys
Focus groups
Public and stakeholder input
10CAHPS 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
11CAHPS 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
12Rationale 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.
13CAHPS- PWMI Consortium A Public-Private
Research Team
AHRQ
Harvard
CDC
Federal Agencies
CAHPS II Consortium
AIR
NIDRR
RAND
Westat
National Rehabilitation Hospital GMU Center for
Health Policy, Research Ethics
14Purpose 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.
15Progress 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
16Planned 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
17Ambulatory Surveys Cover Seven Domains
Customer Service
Access
Office Staff Courtesy, Helpfulness and Respect
Shared Decision-Making
Coordination/Integration
Health Promotion and Education
18Criteria 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
19From Domains to Topics to Items An Example
- 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.
20How Physicians Might Use a CAHPS-PWMI Survey
21Limitations 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.
22Why 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.
23Why 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
24CAHPS 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
25Sample Size Requirements for Varying
Physician-Level Reliability Thresholds
26Stillwater 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
27Stillwater 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
28Stillwater 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.
29Harvard 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.
30HVMA 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
31Harvard 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.
32Questions Answers!