The Agency for Healthcare Research and Quality's (AHRQ’s) CAHPS® Connection is an occasional update for the many users of CAHPS products and survey results. Its purpose is to help you stay informed about new CAHPS products, the product development work of the CAHPS Consortium, and various tools and resources that may be useful to you, such as workshops and educational materials.
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Many health care stakeholders have become interested in the concept of the patient-centered medical home (PCMH). PCMH is an approach to providing comprehensive primary care to patients that involves the personal physician leading and taking responsibility for the ongoing care of his or her patients. The concept of medical home was first introduced in 1967 by the American Academy of Pediatrics (AAP) but primarily referred to a central location for archiving children’s medical records. The concept was expanded by the AAP in 2002 to refer to the following characteristics of medical care: accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally sensitive.
In 2007, the American Academy of Family Physicians (AAFP), the AAP, the American College of Physicians (ACP), and the American Osteopathic Association (AOA) issued a joint statement describing the principles of PCMH that involve:
Read about these principles in: Kellerman R, Kirk L. Principles of the patient-centered medical home. Am Fam Physician. 2007 Sep 15;76(6):774-5. Available at: http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=5605&itool=AbstractPlus-nondef&uid=17910291&db=pubmed&url=http://www.aafp.org/link_out?pmid=17910291.
Review the joint statement at: http://www.medicalhomeinfo.org/joint%20Statement.pdf.
There are many examples of PCMHs including collaboratives, demonstrations, and statewide initiatives. The AAFP conducted a national demonstration with 37 practices. Seventeen states currently have at least one demonstration or pilot program, and five of those States have multiple efforts ongoing. Many of the Robert Wood Johnson’s Aligning Forces for Quality (AF4Q) communities are also implementing medical home initiatives. The largest demonstration is being planned by the Centers for Medicare & Medicaid Services (CMS), which will select practices in up to eight States (pending approval by the U.S. Office of Management and Budget).
Review the Patient-Centered Primary Care Collaborative’s compilation of PCMH pilot and demonstration programs at: http://www.pcpcc.net/content/pcpcc-pilot-projects.
Several early demonstrations have shown significant improvements over traditional models of care.
However, while early results hold promise, the AAFP demonstration found that successful implementation of PCMH requires transformation and changes that can take several years to achieve.4
The National Committee for Quality Assurance’s (NCQA) Physician Practice Connections® – Patient-Centered Medical Home™ program (PPC-PCMH) provides a framework for evaluating PCMHs. This physician recognition program includes nine standards with ten “must-pass” elements; participants can achieve one of the three levels of recognition based on their scores on the standards. Learn more at: http://www.ncqa.org/tabid/631/Default.aspx.
NCQA and others are also discussing how to use CAHPS measures as a way to assess the impact of PCMH on patients. Future issues of The CAHPS Connection will explore how CAHPS surveys may be used for this purpose.
1Steiner BD, Denham AC, Ashkin E, et al. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361-7. 2Margolis PA, Stevens R, Bordley WC, et at. From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children. Pediatrics. 2001;108(3):E42. 3Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff. 2008;27(5):1235-45. 4Nutting PA, Miller WL, Crabtree BF, et al. Initial lessons from the first national demonstration project on the practice transformation to a patient-centered medical home. Ann Fam Med. 2009;7(3):254-260.
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In August 2009, the CAHPS User Network released an updated Survey and Reporting Kit for the CAHPS In-Center Hemodialysis Survey. The 2009 Kit includes:
To view or download documents in this Kit, go to https://www.cahps.ahrq.gov/cahpskit/ICH/ICHchooseQX.asp.
Many users of the CAHPS Clinician & Group Survey have expressed interest in a version that focuses on a specific visit rather than care over the last 12 months. This is the kind of data that many physicians are accustomed to, and they tend to perceive that data as more reliable and credible. Moreover, visit-specific survey results offer more targeted feedback for monitoring and improvement.
To address this need, the CAHPS Consortium has modified the Adult Primary Care Questionnaire to create the Visit Questionnaire. This past June, the CAHPS User Network hosted a Webcast to provide an update on the development of this instrument. This article summarizes the key points.
The Visit Questionnaire includes all of the core items and topics covered in the 12-month version, including access, doctor communication, office staff, and doctor rating. The main difference between the two instruments is the reference period. Other differences include the following:
The first field test of the instrument was conducted in Spring 2009 by Minnesota Community Measurement®, a nonprofit entity whose mission is to improve health care quality through public reporting. Results from the field test led to further refinements to the survey.
The most significant change is to the access items. The field test showed that the visit-specific access items did not function as well as the 12-month version of the items, which had greater reliability. The CAHPS team decided to modify the Visit Questionnaire to measure access over the last 12 months, while the remainder of the survey focuses on a specific visit.
Additionally, the initial draft of the survey asked the respondent about a specific visit that was identified in the sampling frame. This visit may or may not have been the respondent’s most recent visit. To simplify the cognitive task for respondents, the survey now focuses on the "most recent visit" with the doctor.
Further work on the instrument includes cognitive testing as well as additional field testing as opportunities arise. If you are interested in testing the instrument, please contact the CAHPS User Network at cahps1@ahrq.gov.
More information on this questionnaire is available on the CAHPS Web site at: https://www.cahps.ahrq.gov/content/products/CG/PROD_CG_CG40Products.asp.
Materials from the June 2009 Webcast are available at: https://www.cahps.ahrq.gov/content/community/Events/COMM_EVENTS_webcast2009-06-23.asp.
Date: September 24, 2009 Time: 2-3:30 p.m., EST Cost: Free
For more information and to register, go to https://www.cahps.ahrq.gov/content/community/events/COMM_EVENTS_webcast2009-09-24.asp.
The Agency for Healthcare Research and Quality (AHRQ) is hosting a free Webcast for anyone interested in hearing how two medical practices are using the CAHPS Clinician & Group Survey to improve care. The featured speakers include representatives of a primary care group in Massachusetts and a specialty group in California, as well as quality improvement experts from the CAHPS team.
Among the topics to be covered are:
Mark your calendars: April 19-21, 2010 is the date for the Agency for Healthcare Research and Quality’s (AHRQ) 12th National CAHPS User Group Meeting, which is again being held in conjunction with the User Group Meeting for the AHRQ Surveys on Patient Safety Culture (SOPS). Planning is well underway for the meeting, which will take place in Baltimore’s Inner Harbor.
Information about this free event is available now at https://www.cahps-sopsugm.org. Online registration and more details, including hotel and travel information, will be added in November.
This User Group Meeting is designed especially for users of the CAHPS and SOPS surveys. Like the most recent meeting in Phoenix in December 2008, this conference will feature sessions designed specifically for users of each suite of surveys, as well as joint sessions emphasizing common interests.
Review the presentations delivered at the December 2008 meeting.
New users of CAHPS surveys are invited to attend the “CAHPS College,” a half day of free preconference sessions on April 19 designed to orient you to the CAHPS program and its products. Experienced survey users can also attend sessions designed to meet their needs for more technical information. A “SOPS College” will also be available to interested attendees.
The main conference will start on Tuesday, April 20 and run through a half day on Wednesday, April 21. Multiple tracks will address a variety of topics relevant to users including:
The meeting will also offer several opportunities to network with CAHPS grantees, AHRQ staff, and fellow survey users.
If you have already signed up with AHRQ to receive e-mails about CAHPS, you will receive announcements about the meeting. If you have not yet signed up for these updates, please visit https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ.
Every CAHPS survey includes both core items that all sponsors field—thus ensuring standardization in the survey results—as well as supplemental items that are optional. Core items are designed to be applicable across all respondents, regardless of population, payer, or delivery system.
Supplemental items, on the other hand, address issues that may be very important to survey sponsors but pertinent to only a subset of the population (e.g., transportation or use of e-mail). In some cases, the questions are relevant to a larger population but did not meet CAHPS standards for measures of quality when tested in the field. All supplemental items developed by the CAHPS team are provided as part of the CAHPS Survey and Reporting Kits available at: https://www.cahps.ahrq.gov/cahpskit/cahpskit_main.asp. Survey sponsors are also welcome to add their own items to CAHPS surveys.
The topics covered by the CAHPS supplemental item sets vary across surveys. In the Health Plan Survey, they address over 20 topics. They include the “HEDIS Set,” which are items that the National Committee for Quality Assurance adds to the version of the CAHPS Heath Plan Survey that it requires of commercial health plans. There are also extensive sets of items for people with mobility impairments and children with chronic conditions.
In the Clinician & Group Survey, the supplemental item sets vary across the questionnaires for adults and children and the ones for primary and specialty care. The most extensive set is the one that accompanies the Adult Primary Care Questionnaire, with 17 topics including health improvement, health promotion and education, and shared decision making. The new Health Literacy Item Set is designed to supplement this survey.
The general rule is to insert items in the relevant topic sections within the core questionnaire. Grouping all items (core and supplemental) by topic minimizes the cognitive burden on respondents as well as the likelihood of recall or reporting error.
However, before placing the CAHPS supplemental items into the questionnaires, please refer to the guidance in the document with the supplemental items regarding proper item placement. These instructions were designed to ensure that the supplemental items do not interfere with the flow of the core items.
If you plan to add your own questions, append them at the end of an existing section or by adding a new section before the “About You” section of the survey. Adding new items prior to core items creates a different context around the core items and may influence responses to them.
Whenever you add items, be sure to:
This section of The CAHPS Connection provides updates on the activities and products of the CAHPS Database.
This year’s CAHPS Health Plan Survey results will be posted in late September on the CAHPS Database's new online reporting system, available at: https://www.cahps.ahrq.gov/CAHPSIDB/default.aspx.
The reporting system will present national summary-level results for the commercial, Medicaid, and Medicare sectors for the years 2009 and 2008. Users will be able to select specific composites or questions to view, and build their own reports. They can also construct their own version of the Health Plan Survey Chartbook.
In September, Medicaid survey users that contributed data in 2009 will also be able to access individual results through the secure, password-protected area of the online system, which enables them to view their own results compared to selected benchmarks. Individual users will be notified when their results are ready.
Final touches are being made to a new online submission system for users of the CAHPS Clinician & Group Survey. The system will be available for testing in September. If you are interested in participating in the submission system testing, please contact the CAHPS Database at ncbd1@ahrq.gov.
Participation in the Clinician & Group component of the CAHPS Database is open to all health systems, medical groups, practices, and vendors that administer surveys according to CAHPS specifications. The CAHPS Database will support all approved versions of the Clinician & Group Survey, including the 12-month questionnaires with either the 4-point or 6-point response scales and the new visit-specific version of the Clinician & Group Survey.
In 2004, the Agency for Healthcare Research and Quality (AHRQ) released the Hospital Survey on Patient Safety Culture (SOPS), the first in a series of patient safety culture surveys AHRQ is supporting. What are these surveys, and how do they relate to AHRQ’s CAHPS surveys?
The AHRQ Surveys on Patient Safety Culture (SOPS) gather information from health care providers and staff on patient safety culture in three settings:
This program is designed to provide health care facilities with tools they can use to meet the challenge of moving toward a safer health care system. It has three primary goals:
Although the patient safety culture survey items are unique for each setting, there are some similarities in the dimensions of patient safety culture assessed across the surveys. Safety culture dimensions that are covered in each survey are:
The SOPS Comparative Databases are valuable components of the SOPS program:
Hospital SOPS Comparative Database. The Hospital SOPS Comparative Database is a central repository for survey data from hospitals that have administered the AHRQ Hospital SOPS. The 2009 Database contains data from over 600 hospitals and trending data for 204 of those hospitals that submitted to the database more than once. AHRQ produces an annual Comparative Database Report that enables hospitals to compare their patient safety culture survey results with other hospitals.
Nursing Home and Medical Office SOPS Comparative Databases. AHRQ is developing databases and annual reports for these newer surveys that will be modeled after the Hospital SOPS Database and reports. For now, preliminary comparative results are available based on pilot data from 40 nursing homes and 182 medical offices.
AHRQ sponsors both CAHPS and SOPS as part of its mission to equip health care decision makers with useful information and drive improvements in health care quality. (Refer to table below.)
Internet Citation: The CAHPS® Connection. AHRQ Publication No. 09-CAHPS003-EF, Volume 5, Issue 3, September 2009. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.cahps.ahrq.gov/content/CAHPSConnection/files/CAHPSConnectionVolume5Issue3.htm
AHRQ Pub. No. 09-CAHPS003-EF
September 2009
