Download Measuring Patients` Experiences with Care: An Overview

Measuring the Patients’
Experience with Care
Disclosure Project Discussion Forum
July 12, 2007
Dale Shaller, MPA
Shaller Consulting
Managing Director, National CAHPS Benchmarking Database
[email protected]
651-430-0759
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 nation’s health system performing
on key CAHPS measures?
IOM’s 6 Aims for Improvement
Safety
Effectiveness
Patient-Centeredness
Timeliness
Efficiency
Equity
Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academy Press: 2001.
IOM Definition
“Health care that establishes a partnership
among practitioners, patients, and
their families…to 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.
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 Patient’s Eyes. San Francisco: Jossey-Bass: 1993.
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.
Patients Who Experience Worse Hospital Care
Are More Likely to Report Chest Pain 12 Months After AMI
Percent of patients with symptoms
Better Care
100
Worse Care
75
54.5
50
25
37.6
37.5
22.8
0
Chest Pain
Shortness of Breath
Fremont A, et al. Patient-Centered Processes of Care and Long-Term Outcomes of Myocardial Infarction.
JGIM 16 (December 2001): 800-808.
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
Caveat emptor: example of
consumer “convenience” reporting
The Evolution of CAHPS
 “CAHPS” = Consumer Assessment of Healthcare
Providers and Systems
 Most widely used survey tools for measuring the
patient’s 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
Expanding Suite of CAHPS Surveys
Facility Care
 Hospitals
 Dialysis Facilities
 Nursing Homes
Ambulatory Care
Health Plans
Group Practices
Individual Clinicians
Behavioral Health
Organizations (ECHO)
 Home Health




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
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
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)
Major Domains of CAHPS
Health 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)
National CAHPS Benchmarking Database. 2006 CAHPS Health Plan Survey Chartbook. (October 2006)
CAHPS Hospital Survey (H-CAHPS)
 Nation’s 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
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
2006 H-CAHPS Composite Results
Always
Never
77
Doctor Communication
17
69
Nurse Communication
Discharge information
(yes/no)
15
28
16
77
Communication About
Medications
54
20%
9
27
56
Staff Responsiveness
8
25
58
Cleanliness and Quiet
6
23
66
Pain management
0%
Usually
23
19
40%
60%
27
80%
National CAHPS Benchmarking Database. 2007 CAHPS Hospital Survey Chartbook. (May 2007)
100%
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
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
Public Reporting of Survey Measures
 Out of 211 “report cards” in AHRQ’s 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/in
dex.html