Introduction to Patient Experience Surveys

Transcription

1 Introduction to Patient Experience Surveys Dale Shaller, MPA Shaller Consulting Group September 30, 2011

2 Outline Environmental Context Overview of CAHPS Hospital CAHPS (H-CAHPS) Clinician & Group CAHPS (CG-CAHPS) CG-CAHPS Implementation in Wisconsin Questions/Answers 2

3 Forces Driving Measurement Public reporting Aligning Forces for Quality (an initiative of the Robert Wood Johnson Foundation) Chartered Value Exchanges (with DHHS and AHRQ) State mandates CMS Hospital and PhysicianCompare Accountable Care Organizations and Value-Based Purchasing Patient-Centered Medical Home HRSA Bureau of Primary Health Care American Board of Medical Specialties Rising consumer and patient expectations 3

4 Strategies for Measurement Public Reporting Standardized patient surveys Proprietary tools (most focus on satisfaction ) Public domain instruments (CAHPS) User-posted online ratings and reviews Internal Improvement Targeted rapid cycle surveys Focus groups and interviews Walkthroughs Shadowing Mystery shopping 4

5 Caveat emptor: dangers of user-posted online reviews 5

6 CAHPS Program CAHPS = Consumer Assessment of Healthcare Providers and Systems Most widely used survey tools for assessing the patient s experience with care Endorsed by National Quality Forum Initiated and funded by AHRQ since 1995 Consortium members include: AHRQ, CMS, RAND, Yale/Harvard, and Westat 6

7 CAHPS Family of Surveys Ambulatory Care Surveys CAHPS Clinician & Group Survey (CG-CAHPS) CAHPS Health Plan Survey CAHPS Surgical Care Survey CAHPS Home Health Care Survey Facility Surveys CAHPS Hospital Survey (H-CAHPS) CAHPS In-Center Hemodialysis Survey CAHPS Nursing Home Survey 7

8 Core CAHPS Design Principles Focus on topics for which consumers are the best or only source of information Include patient reports and ratings of experiences not satisfaction Base question items and survey protocols on rigorous scientific development and testing, as well as extensive stakeholder input All surveys and services are in the public domain 8

9 CAHPS Hospital Survey (H-CAHPS) Nation s first standardized survey of inpatient experiences with care Developed by AHRQ with substantial stakeholder input and testing Focus on patient reports, not ratings

10 Key Steps in the Development Process 2002: CMS requests development of hospital survey AHRQ issues call for measures Draft survey developed and tested 2003: Field test in pilot states Additional testing with volunteer sites : Multiple rounds of review and public comment NQF endorsement Cost benefit analysis report OMB approval 2006: Vendor training National implementation

11 Dimensions Measured by H-CAHPS Composites: Communication with doctors Communication with nurses Communication about medications Responsiveness of hospital staff Pain management Discharge information Cleanliness Quietness Overall rating Willingness to recommend

12 Public Reporting on Hospital Compare Includes rolling 12 months of data H-CAHPS data refreshed quarterly Current H-CAHPS data (October 2009 September 2010) reflects: 3812 participating hospitals More than 2.7 million completed surveys Hospital participation increased by 54% since first public reporting in March 2008

13 Raising the Stakes: From Pay for Reporting to Pay for Performance

14 National H-CAHPS Performance

15 National Trends Performance has improved for all reported domains/questions since the first public reporting period Ample opportunities for improvement continue to exist 95 th percentile performance nationwide ranges from 72% (for communication about medicines) to 89% (for communication with doctors and discharge information)

16 HCAHPS Online (

17 HCAHPS Adds Value Recent research demonstrates the relationship between HCAHPS performance and performance on other quality and safety indicators In one study, HCAHPS performance was found to be more predictive of readmissions than clinical indicators for acute myocardial infarction, heart failure, and pneumonia

18 CAHPS Clinician & Group Survey Multiple versions to meet user needs 12-month version Visit version Patient-centered medical home (PCMH) version Adult and child versions Core questions are the same across versions Supplemental questions can be added for specific topics 18

19 CG-CAHPS Core Questions (Visit Version) Access to Care: Getting Timely Appointments, Care and Information Getting appointments for urgent care Getting appointments for routine care or check-ups Getting an answer to a medical question during regular office hours Getting an answer to a medical question after regular office hours Wait time for appointment to start Rating and Recommendation Items 0-10 rating of doctor Willingness to recommend to family and friends Follow Up on Test Results Item Office followed up to give test results How Well Doctors Communicate with Patients Doctor explanations easy to understand Doctor listens carefully Doctor gives easy to understand instructions Doctor knows important information about medical history Doctor shows respect for what you have to say Doctor spends enough time with you Courteous and Helpful Office Staff Clerks and receptionists were helpful Clerks and receptionists treat you with courtesy and respect 19

20 CG-CAHPS 12-month Survey Asks about experiences in last 12 months Response scales are never to always 6-point N-A 4-point N-A Sample frame: patients with an office visit during the prior 12 months Works well for assessing experiences that may not apply for every visit (e.g., health promotion, SDM) Commonly used for external reporting 20

21 CG-CAHPS Visit Survey A hybrid combining: 12-month reference period for Access questions (using 4-point N-A scale) Most recent visit question for Doctor Communication and Office Staff and Follow-Up on Test Results (using 3-point Yes-No scale) Sample frame: patients with an office visit in the prior x months, or continuous sampling Considered by many clinicians to be more actionable for improvement 21

22 Profile of Users 12-Month Version Public reporting initiatives in CA, MA, and other markets Some health plans and systems (CA, MI, WI, MA) Department of Defense Visit Version Public reporting initiatives in WI, MN, MI, ME, and other markets Growing numbers of medical practices (including UHC and 6 safety net clinics in CA) Vendors such as Press Ganey, NRC, Avatar ABMS for MOC (Doctor Communication items) 22

23 CG-CAHPS Database Composition (as of December 2010) CG-CAHPS Version N of Practice Sites N of Respondents Adult 12-month 4-pt ,834 Adult 12-month 6-pt ,588 Child 12-month 6-pt 52 4,883 Adult Visit ,442 TOTALS 1, ,747 23

24 Regional Comparisons: Visit Version Top Box Scores 24

25 Physician Specialty Comparisons: Visit Version Top Box Scores 25

26 CG-CAHPS PCMH Survey Collaboration with NCQA for revised PCMH recognition program Based on 12-month reference period (4-point N-A scale) Replaces this doctor with this provider Approved by NCQA s Committee on Performance Measurement on 9/13/11 Final release scheduled for October

27 CG-CAHPS PCMH Survey CAHPS Clinician & Group Core Questionnaire* CAHPS and Other Supplemental Items CAHPS PCMH Survey * NQF endorsed 27

28 PCMH Survey Domains Access to care Communication Information Coordination of Care Comprehensiveness Self Management Support Shared Decision Making 28

29 Other Supplemental Item Sets Health literacy Cultural competence Health information technology (HIT) Persons with mobility impairments (PWMI) Ad hoc quality improvement items 29

30 Regional Implementation Models Centralized Model Single vendor Sample frame drawn from combined files of health plans or medical groups Examples: MHQP, PBGH, CHECKBOOK Decentralized Model Medical practices use their own vendors Integrate CG-CAHPS into current surveys Aggregation of multiple data sets through a neutral vehicle (CAHPS Database) Examples: MN, Detroit, Maine, and WI 30

31 WCHQ Patient Experience Initiative Pilot test of CG-CAHPS decentralized model in 2010 with 9 practice sites: Gunderson Lutheran (3 sites) Luther Midelfort (3 sites) Prevea Health (3 sites) Test results reported in November 2010 Patient Experience Workgroup convened in early 2011 to develop statewide strategy Flexible sampling approach Public reporting of results in 2013 at the clinic site and system level 31

32 WCHQ Pilot Scores Display 32

33 Using CAHPS for Internal Improvement 33

34 CAHPS User Support Services CAHPS Database National voluntary database to support benchmarking and research Online reporting system for comparing and analyzing results Survey and Reporting Kits Instruments and guidance Technical support Phone: