The CAHPS Health Literacy Item Set

1
The CAHPS? Health Literacy Item Set

• Beverly Weidmer, RAND Corporation
• AHRQ 2009 Annual Conference
• Research to Reform Achieving Health System
  Change
• Bethesda, Maryland
• September 15, 2009

2
Acknowledgments

• Funding for this project was provided by the
  Agency for Healthcare Policy and Research
• Our thanks go to the stakeholders who provided
  input on the content of the item set
• Our thanks also go to Affinity Health Plan and
  the University of Mississippi Medical Center for
  participating in the field test of the item set
  and to DataStat, Inc., our data collection
  partner.

3
In memoriam Charles Chuck Darby

• Founding Father of CAHPS, former CAHPS Project
  Officer, mentor, colleague, cherished friend

4
What is CAHPS?

• CAHPS Consumer Assessment of Health Providers
  and Systems
• Program funded by the Agency for Healthcare
  Research and Quality (AHRQ)
• Aim is to produce a set of standardized,
  evidence-based surveys for assessing patients
  experiences with the health care system

5
CAHPS Family of Surveys

• Facility level surveys (hospitals, dialysis
  facilities, nursing homes)
• Ambulatory level surveys (Health Plan, Clinician
  and Group, Dental Plan, etc.)
• Supplemental item sets on special topics (health
  literacy, cultural competence, chronic
  conditions, mobility impairment, etc.)
• Publicly available in both English and Spanish

6
CAHPS Health Literacy Item Set

• Designed to measure patients perspective on how
  well health information is communicated to them
  by healthcare professionals
• Designed as a supplemental item set for the CAHPS
  Clinician and Group Survey
• Developed by CAHPS grantees under the leadership
  of RAND

7
Development and testing

• Adapted from validated measures that are publicly
  available
• Reflects input from health literacy stakeholders
• Validated via cognitive interviews and a field
  test conducted by mail with phone follow up

8
Purpose

• Provide data that can be used to
• Identify areas for quality improvement at the
  clinician and group level
• Evaluate QI activities designed to improve
  communication with patients
• Report quality data back to physicians
• Provide information to consumers

9
Content

• Topics include
• Communication with doctors and nurses
• Communication about health problems/concerns
• Communication about medications
• Communication about tests
• Communication about forms
• All items linked to AMA Foundations
• Health literacy and patient safety help
  patients understand. (Refer to the QI
  Strategies Crosswalk in the CAHPS CG Survey and
  Reporting Kit 2008).

10
Overview

• Twenty-nine items in total
• 2 composites measures
• General Communication (5 items)
• Communication about medications (7 items)
• Users are encouraged to use composite measures
  but may also use individual items if they are
  interested in a specific topic

11
General Communication Composite

• HL9. In the last 12 months, how often did this
  doctor give you all the information you wanted
  about your health?
• HL12. In the last 12 months, how often did this
  doctor give you easy to understand instructions
  about what to do to take care of this illness or
  health condition?
• HL17. In the last 12 months, how often did you
  feel this doctor really cared about you as a
  person?
• HL13. In the last 12 months, how often did this
  doctor ask you to describe how you were going to
  follow these instructions?
• HL25. In the last 12 months, how often were the
  results of your blood test, x-ray or other test
  easy to understand?

12
Communication About Medications Composite

• HL18. In the last 12 months, did this doctor
  prescribe any new medicines or change how much
  medicine you should take?
• HL19. In the last 12 months, how often did this
  doctor give you easy to understand instructions
  about how to take your medicines?
• HL20. In the last 12 months, did this doctor
  explain the possible side effects of your
  medicines?

13
Communication About Medications
Composite--continued

• HL21. In the last 12 months, how often did this
  doctor explain the possible side effects of your
  medicines in a way that was easy to understand?
• HL22. In the last 12 months, other than a
  prescription, did this doctor give you written
  information or write down information about how
  to take your medicines?

14
Communication About Medications
Composite--continued

• HL23. In the last 12 months, how often was the
  written information you were given easy to
  understand?
• HL24. In the last 12 months, how often did this
  doctor suggest ways to help you remember to take
  your medicines?

15
Next steps

• Make items publicly available (http//www.ahrq.gov
  )
• Expected release date Fall 2009
• Develop HCAHPS Health Literacy Item Set

16
HCAHPS Health Literacy Item Set

• Health Literacy supplemental item set for HCAHPS
  currently under development
• Expected release date in Spring 2010
• Domains include
• Patient-provider communication
• Discharge planning
• Communication about medications
• Communication about test results
• Communication about forms

17
Questions?

• Contact
• Beverly Weidmer
• RAND Corporation
• 1776 Main St.
• Santa Monica, CA 90401
• [phone], ext. 6788
• Beverly_Weidmer_at_rand.org