Developing CAHPS for People with Mobility Impairments

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Developing CAHPS for People with Mobility
Impairments

• June 8, 2005
• Marybeth Farquhar
• Sue Palsbo

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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

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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.

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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

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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

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Example Maryland Medicaid Report Card (2004)
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How Maryland State Collected the Information
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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
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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
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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

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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

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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.

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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
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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.

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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

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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

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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
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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

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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.

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How Physicians Might Use a CAHPS-PWMI Survey
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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.

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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.

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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

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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

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Sample Size Requirements for Varying
Physician-Level Reliability Thresholds
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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
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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

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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.

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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.

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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

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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.

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Questions Answers!