CAHPS® Nursing Home Survey: Discharged Resident (Text Version)

Slide Presentation from the AHRQ 2011 Annual Conference

Slide presentation from the AHRQ 2011 conference.

CAHPS® Nursing Home Survey: Discharged Resident

Slide Presentation from the AHRQ 2011 Annual Conference

On September 20, 2011, Nicholas Castle made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1 MB). Plugin Software Help.

Slide 1

Slide 1. CAHPS® Nursing Home Survey: Discharged Resident

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

Slide 2. Introduction

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

Slide 3. Introduction (continued)

Introduction (continued)

Agency for Healthcare Research and Quality (AHRQ):
- 1R03 HS018696 (Satisfaction of discharged nursing home residents).

Slide 4

Slide 4. Introduction (continued)

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

Slide 5. Introduction (continued)

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

Slide 6. Introduction (continued)

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

Slide 7. Background

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

Slide 8. Background

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

Slide 9. Figure 1: Steps in Discharged Resident AND Long Stay CAHPS Development

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

Slide 9. Figure 1: Steps in Discharged Resident AND Long Stay CAHPS Development

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

Slide 11. Domain and Items

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

Slide 12. Methods

Methods

Discharged residents from 500 nursing homes will be used:
- As of Aug 2011:
  - 120 nursing homes.
  - 1,700 returns.
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.