CAHPS Driven Quality Improvement: Primary Care

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CAHPS Driven Quality Improvement Primary Care

• Susan Edgman-Levitan,PA
• Executive Director
• Stoeckle Center for Primary Care Innovation
• Massachusetts General Hospital
• Co-PI, Yale/Harvard CAHPS Team

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IFCC Core Concepts of Patient and Family-Centered
Care

• Dignity and Respect. Health care practitioners
  listen to and honor patient and family
  perspectives and choices. Patient and family
  knowledge, values, beliefs and cultural
  backgrounds are incorporated into the planning
  and delivery of care.
• Information Sharing. Health care practitioners
  communicate and share complete and unbiased
  information with patients and families in ways
  that are affirming and useful. Patients and
  families receive timely, complete and accurate
  information in order to effectively participate
  in care and decision-making.

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IFCC Core Concepts of Patient and Family-Centered
Care

• Participation. Patients and families are
  encouraged and supported in participating in care
  and decision-making at the level they choose.
• Collaboration. Patients, families, health care
  practitioners, and health care leaders
  collaborate in policy and program development,
  implementation and evaluation in facility
  design and in professional education, as well as
  in the delivery of care.

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Dimensions of Patient and Family-Centered Care

• In addition to safe and technically excellent
  care, patients and families identify the
  following specific dimensions as the most
  critical aspects of the ambulatory care
  experience
• Access
• Respect for patients values and preferences
• Coordination of care
• Information, communication, and education
• Emotional support
• Involvement of friends and family

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Clinician-Group CAHPS and Patient and Family-
Centered Care

• Getting Appointments and Health Care When Needed
• Access to information and appointments
• Waiting times in the office and exam room
• How Well Doctors Communicate
• Respect for patient preferences
• Clear and understandable information about
  diagnosis, treatments, and medications
• Listening and empathy
• Courteous and Helpful Office Staff
• Respectful, helpful, and courteous office staff
• Overall Rating

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The CAHPS Improvement Guide

• A resource manual for health plans and medical
  groups seeking to improve their CAHPS scores
• Funded by CMS (Medicare) and developed by Harvard
  Medical School CAHPS Team
• Over 2 dozen strategies mapped to CAHPS core
  questions

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Section 1. Setting the Stage An Infrastructure
that Supports Improved Performance
Section 2. Identifying Opportunities to Improve
A Guide to the CAHPS QI Guidebook
For each opportunity
Section 3. Implementing the CAHPS Improvement
Cycle
Plan Strategy - Create team (if needed) -
Establish/confirm goals - Investigate potential
interventions (see Section 4)
Section 4.Ideas for Improving Experiences with
Care

• Develop and Test Strategy
• - Select measures to monitor progress
• Develop changes using selected intervention
• Conduct small tests of change
• Adapt changes to organizational context
• - Identify and deal with barriers

Reassess Respond - Use CAHPS data to assess
what worked, what didnt - Spread successful
innovations
Getting needed care
Getting care quickly
Doctors communicate well
Customer service
Home health preventive services
Claims Processing
Monitor Strategy - Implement changes and hold the
gains - Evaluate progress against criteria
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CAHPS and Quality Improvement

• CAHPS III
• Refining QI model for implementing patient and
  family-centered care
• Creation of a meta-model to guide practice
  redesign and implementation of patient and
  family-centered care
• Updating of CAHPS Improvement Guide to link with
  new Health Plan and Clinician-Group CAHPS surveys
• Conversion to a web-based document to improve
  access and linkages to CAHPS reports.

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Factors That May Contribute to Measurable and
Sustained Improvement

• Leadership is committed and engaged
• Strategic goals are aimed at organizational
  transformation
• Focusing on involving patients and families in
  redesign and improvement activities.
• Focus on employee, clinician, and patient
  satisfaction.
• Internal communication and action are aligned
  with strategic goals
• Motivation through external rewards and
  incentives

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Strategies for Clinician-Group CAHPS QI

• Link patient experience of care data to internal
  incentive programs
• Link patient experience of care data to external
  P4P programs
• data to P4P and other incentives
• Collect and report physician-level data

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Honest criticism is hard to take, particularly
from a relative, a friend, an acquaintance, or a
stranger.Franklin P. Jones
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Strategies for Clinician-Group CAHPS QI

• Perform analyses that address 50 ways to deny
  the data
• Staff surveys
• Educational efforts at multiple levels of the
  organization
• Link to other performance data
• Panel size
• Practice design
• HEDIS data

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