Master Slide
Download
Report
Transcript Master Slide
Measuring the Patients’
Experience with Care
Disclosure Project Discussion Forum
July 12, 2007
Dale Shaller, MPA
Shaller Consulting
Managing Director, National CAHPS Benchmarking Database
[email protected]
651-430-0759
Presentation Outline
What is the “patient experience with care”?
Why is it important?
How can it be measured?
What is the unique contribution of CAHPS® to
measuring the patient experience?
How is the nation’s health system performing
on key CAHPS measures?
IOM’s 6 Aims for Improvement
Safety
Effectiveness
Patient-Centeredness
Timeliness
Efficiency
Equity
Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academy Press: 2001.
IOM Definition
“Health care that establishes a partnership
among practitioners, patients, and
their families…to ensure that decisions
respect patients’ wants, needs, and
preferences and that patients have the
education and support they need to
make decisions and participate in their
own care.”
Institute of Medicine. Envisioning the National Health Care Quality Report. Washington, DC:
National Academy Press: 2001.
Picker Dimensions
Respect for patient values, preferences
Coordination and integration
Information, communication, education
Physical comfort
Emotional support
Involvement of family and friends
Transition and continuity
Access to care
Gerteis M, et al. Through the Patient’s Eyes. San Francisco: Jossey-Bass: 1993.
Patient experience is strongly
correlated with other key outcomes
Health Outcomes:
Patient adherence
Process of care measures
Clinical outcomes
Business Outcomes:
Patient loyalty
Malpractice risk reduction
Employee satisfaction
Financial performance
Edgman-Levitan S., Shaller D. et al. The CAHPS Improvement Guide. Boston: Harvard Medical School: 2003.
Patients Who Experience Worse Hospital Care
Are More Likely to Report Chest Pain 12 Months After AMI
Percent of patients with symptoms
Better Care
100
Worse Care
75
54.5
50
25
37.6
37.5
22.8
0
Chest Pain
Shortness of Breath
Fremont A, et al. Patient-Centered Processes of Care and Long-Term Outcomes of Myocardial Infarction.
JGIM 16 (December 2001): 800-808.
Approaches to measuring patient
experience with care
Patient surveys
Proprietary tools
Public domain instruments (CAHPS)
Focus groups and interviews
Walkthroughs
“Mystery shopping”: participant observation
by trained informants
Web-based “convenience” reporting
Caveat emptor: example of
consumer “convenience” reporting
The Evolution of CAHPS
“CAHPS” = Consumer Assessment of Healthcare
Providers and Systems
Most widely used survey tools for measuring the
patient’s experience with care
CAHPS Consortium initiated and funded by AHRQ
since 1995:
CAHPS I: Focus on health plans and consumer choice
CAHPS II: Expansion of survey instruments
CAHPS III: New focus on QI and reporting applications
Current consortium members include: AHRQ, CMS,
AIR, RAND, Yale/Harvard, and Westat
Expanding Suite of CAHPS Surveys
Facility Care
Hospitals
Dialysis Facilities
Nursing Homes
Ambulatory Care
Health Plans
Group Practices
Individual Clinicians
Behavioral Health
Organizations (ECHO)
Home Health
Common CAHPS Design Principles
Include reports and ratings of experiences –
not “satisfaction”
Standardization to enable valid comparisons
(through CAHPS Database)
Content based on evidence of what patients
want to know and for which they are the best
or only source of information
Question items and survey protocols based
on rigorous scientific development and
testing, as well as stakeholder input
Common CAHPS Design Principles
(continued)
A core set of question items with option to
add from a bank of tested supplemental
questions:
Special populations (e.g., chronic conditions,
persons with mobility impairments)
Quality improvement applications
Focus on development of reports as well as
survey instruments
All CAHPS surveys and services are in the
public domain
CAHPS Health Plan Survey
Over 138 million Americans are enrolled in
health plans that are assessed using CAHPS
Major users:
Federal purchasers: CMS, OPM, DoD
NCQA: Health plan accreditation
State Medicaid Agencies
Health plans
Employer coalitions (e.g., NBCH eValue8)
Major Domains of CAHPS
Health Plan Survey 4.0
Access: getting needed care
Access: getting care quickly
Doctor communication
Health plan customer service, information,
and paperwork
Global ratings (overall care, health plan,
personal doctor, specialist)
National CAHPS Benchmarking Database. 2006 CAHPS Health Plan Survey Chartbook. (October 2006)
CAHPS Hospital Survey (H-CAHPS)
Nation’s first standardized survey of inpatient
experiences with care
Endorsed by National Quality Forum in 2005
Centers for Medicare and Medicaid (CMS):
2007 H-CAHPS reporting tied to hospital payment
increases
Public reporting in March 2008
Dimensions Measured by H-CAHPS
Composites:
Communication with doctors
Communication with nurses
Communications about medications
Pain management
Cleanliness and quiet of hospital environment
Discharge information
Overall rating
Willingness to recommend
2006 H-CAHPS Composite Results
Always
Never
77
Doctor Communication
17
69
Nurse Communication
Discharge information
(yes/no)
15
28
16
77
Communication About
Medications
54
20%
9
27
56
Staff Responsiveness
8
25
58
Cleanliness and Quiet
6
23
66
Pain management
0%
Usually
23
19
40%
60%
27
80%
National CAHPS Benchmarking Database. 2007 CAHPS Hospital Survey Chartbook. (May 2007)
100%
CAHPS Clinician & Group Survey
Adopted by AQA and submitted for endorsement by
NQF
Adult, pediatric, and specialty versions
Core composites:
Access: Getting appointments and care when needed
Doctor communication
Office staff courtesy and helpfulness
Many supplemental items:
Health promotion and education
Shared decision making
QI items
Visit-specific questions
Implementation Models for CAHPS
Clinician & Group Survey
Regional collaboratives
BQI markets
Aligning Forces markets
Accreditation/certification
American Board of Medical Specialties
National health plan consortium
CSS initiative
Independent efforts
Health plans
Medical groups
Public Reporting of Survey Measures
Out of 211 “report cards” in AHRQ’s Report
Card Compendium:
113 include patient experience measures
69 health plan reports
20 medical group/clinic reports
19 hospital reports
3 nursing home reports
2 individual physician reports
http://www.talkingquality.gov/compendium/in
dex.html