CAHPS® Nursing Home Survey: Discharged Resident (Text Version)
On September 20, 2011, Nicholas Castle made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1 MB). .
Slide 1
CAHPS® Nursing Home Survey: Discharged Resident
Nicholas G. Castle, Ph.D.
CastleN@Pitt.edu
AHRQ 2011 Annual Conference:
Leading Through Innovation & Collaboration
Graduate School of Public Health
University of Pittsburgh
Draft Results
Slide 2
Introduction
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS®):
- Family of survey instruments.
- 3 Nursing home survey instruments.
- CAHPS® Nursing Home Survey of discharged nursing home residents' experiences:
- Remains to be fully developed.
Slide 3
Introduction (continued)
- Agency for Healthcare Research and Quality (AHRQ):
- 1R03 HS018696 (Satisfaction of discharged nursing home residents).
Slide 4
Introduction (continued)
CAHPS® Nursing Home Survey of discharged nursing home residents' experiences.
- Has considerable relevance:
- More than half of all elders cared for in nursing homes are now discharged home (CMS, 2009).
- Satisfaction information from current residents is different from those elders discharged home:
- i.e., short-stay vs. long-stay differences.
- Different populations with different needs in the nursing home.
- Measuring satisfaction is necessary to understand patient preferences (IOM, 2001).
Slide 5
Introduction (continued)
- Consumer satisfaction is an important indicator of quality of care (Gesell, 2001; Pearson, Hocking, Mott & Riggs, 1993; Uman & Urman, 1997; Kane & Wilson, 1993).
- Resident satisfaction data provide information about the quality of care that is different from information from clinical indicators, family members, nursing home staff, or regulatory practices or evaluations (Berlowitz, Du, Kazis, & Lewis, 1993; Lavizzo-Mourey, Zinn, & Taylor, 1992; Uman & Urman, 1997).
- Satisfaction could have far-reaching consequences for resident and family behavior:
- For example, in 24.1% of cases, dissatisfaction with quality of care led to residents' choosing to depart from a particular facility (Phillips, Hawes, Spry, & Rose, 2000).
Slide 6
Introduction (continued)
- Satisfaction could have far-reaching consequences for resident and family behavior:
- For example, in 24.1% of cases, dissatisfaction with quality of care led to residents' choosing to depart from a particular facility (Phillips, Hawes, Spry, & Rose, 2000).
- Used as a mail survey, has considerable cost advantages.
Slide 7
Introduction (continued)
- The standardization and reliability that CAHPS® Nursing Home Survey of discharged nursing home residents' experiences provides could facilitate the same benefits we have seen in other industries for the CAHPS® family of instruments:
- Quality improvement.
- Reimbursement.
- Public reporting.
- Benchmarking.
Slide 8
Background
- Was developed by AHRQ and the CAHPS® consortium of Harvard Medical School, The RAND Corporation, Research Triangle Institute International, and the American Institutes for Research in collaboration with the Centers for Medicare & Medicaid Services (CMS).
Slide 9
Figure 1: Steps in Discharged Resident AND Long Stay CAHPS Development
Phase 1: Resident Survey—Feasibility
1 Literature Review completed May 2000.
2 Interviews with Experts.
3 Methodological Expert Group (MEG) meeting—June 2000.
Phase 2: Resident Survey—Instrument Development
1 Focus groups with residents and family members—Spring 2001
2 Cognitive testing for Quality of Care items
a Round 1—Fall 2001 (52 residents in 5 homes)
b Round 2—Spring 2002 (15 residents in 3 homes)
c Round 3—Spring 2002 (19 residents in 3 homes)
c Round 4—Spring 2003 plus vignette testing (27 residents in 3 homes)
e Round 5—Summer 2003 plus vignette testing (31 residents in 3 homes)
3 Draft Instrument for Resident NHCAHPS—Fall 2003
4 CMS Decision to Merge Kane's Quality of Life (QOL) items from Study—Fall 2003
5 Selection of QOL items Fall 2003-Summer 2004
6 Cognitive testing for Quality of Life items
a Round 6—Fall 2004-Winter 2005 (16 residents in 2 homes)
b Round 7—Spring 2005 (19 residents in 2 homes)
b Round 8—Late 2005 additional cognitive testing
Slide 10
Figure 1: Steps in Discharged Resident AND Long Stay CAHPS Development
Phase 4: Resident Discharge Survey—Field Test
3 Pretest of Instrument— May 2006
3 NQF review May 2010 (short stay received time limited endorsement; long stay was endorsed)
3 Fall 2010 Transition items added after NQF review for testing
3 Spanish translation May 2011
Slide 11
Domain and Items | Long-stay survey | Short-stay survey |
---|---|---|
1. Environment | ||
Rate food | √ | √ |
Rate meal enjoyment | √ | √ |
Rate temp comfort | √ | √ |
Rate cleanliness | √ | √ |
Rate safety & security | √ | √ |
Area around room quiet at night | √ | √ |
Bothered by noise in day | √ | √ |
Private place for visiting | √ | √ |
Room setup so you can get things w/o help | √ | √ |
2. Care | ||
Rate therapy received | √ | |
Rate how well medicine helps w/pain | √ | √ |
Rate how well staff helps w/pain | √ | √ |
Rate speed of staff response | √ | √ |
Rate how gentle staff are | √ | √ |
Staff make sure you have privacy | √ | √ |
3.Communication & respect | ||
Rate staff respectfulness | √ | √ |
Rate how well staff listen to you | √ | √ |
Rate how clearly staff explain things to you | √ | √ |
4. Autonomy | ||
Choose time to go to bed | √ | √ |
Choose what clothes to wear | √ | √ |
Choose what activities to do here | √ | √ |
5. Activities | ||
Enough organized activities on weekends | √ | √ |
Enough organized activities during week | √ | √ |
6. Transitions | √ | √ |
What number would you use to rate how well your discharge needs were met? | √ | |
Before leaving the nursing home, did the nursing home staff talk with you about whether you would have the help you needed after you left? | √ |
Slide 12
Methods
- Discharged residents from 500 nursing homes will be used:
- As of Aug 2011:
- 120 nursing homes.
- 1,700 returns.
- As of Aug 2011:
- Applied properties.
- Psychometrics:
- Confirmatory factor analysis (CFA) used to test the extent to which the items in each domain appear to represent the same underlying construct as long stay instrument.
- Test transition items.
Slide 13
Q1. How Was the Food at the Nursing Home?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 1% |
1 | 2% |
2 | 2% |
3 | 4% |
4 | 5% |
5 | 9% |
6 | 13% |
7 | 15% |
8 | 19% |
9 | 17% |
10 | 13% |
Slide 14
Q3. What Number Would You Use to Rate How Much You Enjoyed Mealtimes?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 0% |
1 | 2% |
2 | 2% |
3 | 4% |
4 | 4% |
5 | 8% |
6 | 11% |
7 | 15% |
8 | 23% |
9 | 12% |
10 | 20% |
Slide 15
Q4. What Number Would You Use to Rate How Comfortable the Temperature Was in the Nursing Home?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 0% |
1 | 1% |
2 | 1% |
3 | 0% |
4 | 2% |
5 | 7% |
6 | 6% |
7 | 8% |
8 | 23% |
9 | 26% |
10 | 26% |
Slide 16
Q8. What Number Would You Use to Rate How Well the Medicine to Help With Aches or Pain Worked?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 0% |
1 | 0% |
2 | 1% |
3 | 1% |
4 | 1% |
5 | 4% |
6 | 7% |
7 | 15% |
8 | 26% |
9 | 21% |
10 | 23% |
Slide 17
Q11. What Number Would You Use to Rate How Quickly the Nursing Home Staff Came When You Called For Help?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 1% |
1 | 0% |
2 | 1% |
3 | 3% |
4 | 2% |
5 | 5% |
6 | 5% |
7 | 10% |
8 | 23% |
9 | 25% |
10 | 26% |
Slide 18
Q45. What Number Would You Use to Rate How Well Your Discharge Needs Were Met?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 0% |
1 | 0% |
2 | 0% |
3 | 1% |
4 | 1% |
5 | 4% |
6 | 1% |
7 | 7% |
8 | 16% |
9 | 25% |
10 | 45% |
Slide 19
Q20. What Number Would You Use to Rate the Nursing Home?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
0 | 0% |
1 | 0% |
2 | 0% |
3 | 1% |
4 | 1% |
5 | 2% |
6 | 3% |
7 | 7% |
8 | 18% |
9 | 24% |
10 | 44% |
Slide 20
Q39. Would You Recommend the Nursing Home to Others?
Image: A bar graph presents the following results to the question above:
Response | Percent |
---|---|
Probably No | 3% |
Definitely No | 3% |
Probably Yes | 16% |
Definitely Yes | 79% |
Slide 21
Item/Domain | Primary Factor Loadings | Missing responses | Floor | Ceiling | Mean | Standard deviation | Item-scale correlation | Cronbach's alpha coefficients |
---|---|---|---|---|---|---|---|---|
Meals | 0.82 | |||||||
Q1. What number would you use to rate the food at the nursing home? | 0.76 | 1.4% | 1.1% | 22.4% | 8.00 | 2.40 | 0.61 | |
Comfort and Cleanliness | 0.83 | |||||||
Q4. What number would you use to rate how comfortable the temperature was in the nursing home? | 0.70 | 2.2% | 2.9% | 19.1% | 6.98 | 2.75 | 0.69 | |
Safety and Security | 0.76 | |||||||
Q6. What number would you use to describe how safe and secure you felt in the nursing home? | 0.71 | 1.7% | 1.8% | 24.6% | 7.83 | 2.52 | ||
Medication and Pain Management | 0.66 | 2.4% | 1.1% | 23.1% | 7.73 | 2.54 | 0.53 | 0.81 |
Q8. Thinking about when you were in the nursing home, what number would you use to rate how well the medicine to help with aches or pain worked? | 0.72 | 1.9% | 1.1% | 21.3% | 7.09 | 2.58 | 0.48 | |
Nursing Home Staff | 0.77 | |||||||
Q11. What number would you use to rate how quickly the nursing home staff came when you called for help? | 0.67 | 3.4% | 0.7% | 26.2% | 7.63 | 2.46 | 0.59 | |
Services | 0.80 | |||||||
Q18. When you were in the nursing home, did you have any special therapy, such as physical, occupational, or speech therapy? | 0.62 | 2.6% | 1.7% | 23.7% | 8.38 | 2.01 | 0.60 | |
Nursing Home Environment | 0.86 | |||||||
Q21. When you were in the nursing home, was the area around your room quiet at night? | 0.70 | 1.2% | 0.4% | 18.4% | 6.98 | 2.59 | 0.63 | |
Visitors | 0.75 | |||||||
Q23. When you were in the nursing home, did you have any visitors? | 0.76 | 3.2% | 1.4% | 19.8% | 7.48 | 2.44 | 0.63 | |
Medical Care and Ability | 0.78 | |||||||
Q25. When you were in the nursing home, did you visit a doctor for medical care outside the nursing home? | 0.71 | 1.2% | 3.8% | 19.5% | 7.18 | 2.34 | 0.52 | |
Autonomy | 0.74 | |||||||
Q32. When you were in the nursing home, did the staff help you dress, take a shower, or bathe? | 0.72 | 1.9% | 1.1% | 21.3% | 7.09 | 2.58 | 0.48 | |
Leaving the Nursing Home | 0.71 | |||||||
Q45. What number would you use to rate how well your discharge needs were met? | 0.73 | 1.8% | 2.4% | 22.9% | 7.72 | 2.41 | 0.57 |
Slide 22
Summary
- Draft.
- Applied properties:
- Very few missing items (etc).
- Favorable resident response rates (42% – 79%).
- Psychometrics:
- Incomplete.
- Comparison with long-stay instrument:
- Seem similar in several areas:
- Based on summary scores.
- Seem similar in several areas:
- Transition items:
- Seem to perform well.