` RYAN WHITE PART A QUALITY MANAGEMENT PROGRAM HOUSTON EMA CLIENT SATISFACTION REPORT, 2010 PREPARED BY HARRIS COUNTY PUBLIC HEALTH & ENVIRONMENTAL SERVICES RYAN WHITE GRANT ADMINISTRATION APRIL 2011 CONTACT: Carin Martin, MPA Project Coordinator - Quality Management Development 2223 West Loop South, RM 417 Houston, TX 77027 713-439-6041 cmartin@hcphes.org
Table of Contents INTRODUCTION 2 METHODS 2 SURVEY ADMINISTRATION 2 SURVEY RESPONDENTS DEMOGRAPHICS 3 AGE 3 GENDER 3 RACE 4 ETHNICITY 5 STAGE OF ILLNESS Error! Bookmark not defined. FINDINGS 6 System-Wide Overall Satisfaction Results 6 Outpatient/Ambulatory Care Services 8 Case Management Services 10 CONCLUSIONS 12 ATTACHMENTS 13 1
INTRODUCTION Ryan White Grant Administration has collected client satisfaction data since 2002. Client satisfaction is one method Ryan White Grant Administration uses to measure the quality of Part A funded HIV care delivery in the Houston Eligible Metropolitan Area (EMA). Client satisfaction measurement activities in the Houston EMA are designed to assess satisfaction with Part A services, to highlight agency strengths, and to identify areas where clients may have problems with service delivery. Data are collected using standardized client satisfaction surveys for each service provided through Part A of the Ryan White Program. The survey tools were developed to gather information on both service-specific and agency-focused topics. Each Part A service category utilizes a unique survey tool, with certain agency-focused questions being common to all surveys. This methodology allows for analysis of satisfaction with care using a standardized approach which ensures apples to apples comparisons across provider agencies and service areas. This also allows for examination of general trends in satisfaction each year. Part A funded services which were surveyed during the 2010 data collection period include outpatient/ambulatory care, case management, dental care, transportation, legal, local pharmacy assistance program, health insurance assistance, nutritional supplements, substance abuse, vision care, and rehabilitation. The service specific results presented in this report are limited to outpatient/ambulatory care and case management services as these are two of the most critical services provided to clients through Part A in the Houston EMA. However, the results for all services surveyed in 2010 are attached. METHODS In 2010, Ryan White Grant Administration Section within Harris County Public Health and Environmental Services (the administrative body for Ryan White Part A funds in the Houston EMA) conducted an evaluation of clients satisfaction with the provision of services by Part A funded providers. A convenience sample was used to obtain respondents (i.e., clients who received services during the data collection period were asked to complete a survey). Data collection commenced with the start of the 2010 fiscal year in March 2010 and concluded with the close of FY 10 at the end of February 2011. For each Part A service category, Ryan White Grant Administration requested that a minimum of 10% of the total client population be surveyed. The number of surveys to be collected from each provider is proportional to the number of clients served at that site. SURVEY ADMINISTRATION FY 2010 marked the 2 nd year of on-line client satisfaction survey availability for all Part A funded providers participating in the client satisfaction process. The on-line survey is identical in form and content to the bar-code generated surveys that have historically been used in EMA client satisfaction survey collection. Most service providers participated in Ryan White Grant Administration s expansion of its web based survey process to measure client satisfaction. Participating service providers solicited on-line survey completion from March through November. Clients completing the web based survey were given a deidentifying survey ID along with an instruction sheet on how to access the survey website. Clients then completed the surveys using computers located at the agency or elsewhere in the community (e.g. library, work, home, etc.). If service providers did not collect the 2
requisite 10% target by the last quarter of the fiscal year, lock-boxes were employed to collect the remainder. All bar-coded surveys and on-line survey ID s were generated from the Centralized Patient Care Data Management System (CPCDMS) for each client who agreed to complete a survey. Clients that completed the survey using the bar-coded questionnaire placed it in a secure lock-box (provided to each agency) or mailed in their completed questionnaire using a postage paid envelope provided to agencies by Ryan White Grant Administration. In 2010, Approximately 5,507 surveys were distributed and a total of 2,068 surveys were completed, representing a 38% response rate. Approximately 29 surveys were returned in Spanish compared to 150 in 2009. SURVEY RESPONDENTS DEMOGRAPHICS An analysis of respondent demographics was conducted in order to compare the Houston EMA s general client population to those who submitted client satisfaction surveys. This analysis enables Ryan White Grant Administration to determine whether the respondent population is representative of the entire client population. The CPCDMS provided demographic information on a representative sample of clients served in the Houston EMA during the data collection period of the client satisfaction survey. Please note that demographic comparisons are based on the entire Houston EMA population served between March 1, 2009 and February 28, 2010. AGE The age of survey respondents was consistent with the general client population served in the Houston EMA. Individuals in the 35-44 yr. old and 45-54 yr. old categories each represent approximately one-third of the population for both survey respondents and the EMA as a whole. Please note that the categorical break down for age differs slightly. Age of Survey Respondents Age of Houston Part A Client Population 40.00% 40.00% 30.00% 30.00% 20.00% 20.00% 10.00% 10.00% 0.00% 20-24 25-34 35-44 45-54 55-64 65 and older 0.00% 0-24 25-34 35-44 45-54 55-64 65 and older 3
GENDER The genders of survey respondents were nearly identical to that of the total Houston EMA client population. Twenty-five percent of survey respondents were female and 73.8% were male, as is the case in the general population (transgender survey respondents constituted less than 1% of total survey respondents and less than 1% of the total Houston EMA population served under Part A. RACE There are very little differences between the races of survey respondents compared to the racial make-up of clients served under Part A. Blacks constituted approximately 54% of survey respondents and 53% clients served in the Houston EMA. Similarly, 46% of survey respondents were White and White clients represent 45% of the Houston EMA population served. All other race categories made up less than 1% each of both survey respondent and EMA populations. 4
ETHNICITY There are also virtually no differences between the ethnicity of survey respondents compared to the ethnicity of clients served under Part A as a whole. Non-Hispanics constituted 75% of survey respondents and 74% of clients served in the Houston EMA. Similarly, 26% of survey respondents were Hispanic and Hispanic clients represent 25% of the Houston EMA population served. 5
FINDINGS Service specific findings presented in this briefing reflect findings for those services most utilized by clients and for those services which are provided at multiple sites (i.e., primary care and case management). System-wide satisfaction results are an aggregate of all service categories. In general, across all agencies that provide primary care and case management services, there was a high level of satisfaction among all clients. Additionally, there were no notable differences in satisfaction by race and gender among these agencies. (Note: this result reflects an aggregate analysis of all sites providing primary care and case management services only). A few highlights are presented below. SYSTEM-WIDE OVERALL SATISFACTION RESULTS Ninety-nine percent of clients reported being very satisfied or satisfied with the quality of services received across all agencies and service areas. This rate remained stable when compared to 2008 and 2009 client satisfaction findings. Ninety-nine percent of clients reported they would very highly or highly recommend the agencies to others. This rate increased from 98% in 2009. The rate of clients reporting they would very highly recommend the agencies to others decreased slightly from 2009 to 2010 from 74% to 73%. 6
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OUTPATIENT/AMBULATORY CARE SERVICES Four agencies provide outpatient/ambulatory care services to adult clients. Approximately six hundred seventy (670) clients returned client satisfaction surveys about their experience with outpatient/ambulatory care services. In general, there was a high level of satisfaction with care and services provided across agencies. For example, 96% of clients reported feeling comfortable with asking their doctor/clinician questions ( always and most of the time ). Ninety-nine percent of clients feel that the care received from these agencies helped to improve their health status ( very much or some ). Additional results are presented below. Ninety-nine percent of clients felt that their doctor/clinician treated them with dignity and respect always or most of the time. Additionally, the rate that patients report they felt their doctor/clinician always treated them with dignity and respect, has maintained consistently high levels of satisfaction; 92% in 2007, 94% in 2008, 93% in 2009 and 92% in 2010. Ninety-nine percent of clients reported being very satisfied or satisfied with the quality of service they receive from outpatient/ambulatory care providers. This rate was stable between 2006 and 2010. However, there was a significant decrease in the rate of clients reporting they were very satisfied with the quality of service from 80% in 2009 to 70% in 2010. 8
Ninety-eight percent of clients reported they would very highly or highly recommend the agencies to others. This rate has remained stabled over the past several years. However, again there was a significant decrease in the rate of clients reporting they would very highly recommend the agencies from 77% in 2009 to 69% in 2010. This rate was as high as 84% in 2007. 9
CASE MANAGEMENT SERVICES Approximately six-hundred forty clients returned client satisfaction surveys about their experience with case management services. In general, there was high level of satisfaction with case management services provided across agencies. For example, 97% of clients were very satisfied or satisfied with their case manager s knowledge of community services and his/her ability to connect them with those services. Ninety-four percent of clients (very much or some ) felt that the case management received from these agencies has helped them to improve their problems, feelings, or situations that brought them to those agencies. Additional results are presented below. Ninety-five percent of clients felt their case manager treated them with dignity and respect always or most of the time. This rate has been stable since for several years. The percentage of clients who felt they were always treated with dignity and respect saw a slight decrease to 85% from the 2009 rate of 88%. However the 2009 rate established a marked improvement after several years of decline from 91% in 2006 and 86% in 2007, to 77% in 2008. One-hundred percent of clients reported being satisfied with the overall quality of care they received from case management providers. This rate was stable between 2006 and 2010. The percentage of clients reporting being very satisfied with service received showed continued improvement to 82% from last year s rate of 76%. 10
The rate of clients reporting they would very highly or highly recommend the agencies to others increased to 98% from 2009 in 97%. The number of clients reporting they would very highly recommend these agencies also rose to 77% in 2010 from 70% in 2009. 11
CONCLUSIONS In general, there was a high level of satisfaction with the quality of care received from primary care and case management providers in the Houston EMA. Although a convenience sample was utilized to obtain survey respondents, there was close consistency between the demographics make-up of survey respondents compared to the general client population. The most notable decrease in client satisfaction is with Primary Care services. Survey results indicate that patients still maintain a positive relationship with their doctor, as demonstrated by 99% of clients reporting that their doctor treats them with dignity and respect and 96% indicating that they feel comfortable asking their doctor questions. However, question meant to elicit overall satisfaction with primary care service, such as Overall satisfaction with service and Recommending the provider to others show significant decline. A 10% decrease and an 8% decrease respectively. Although providers should pay close attention to these rates for possible issues with service delivery, it should be noted that most primary care provider in the Ryan White system of care implemented office visit co-pays using sliding fee scales. This no doubt contributes to overall satisfaction with their primary care provider. 12
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