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

Slide presentation from the AHRQ 2011 conference.

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


Slide 1

Description below image.

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

Description below image.

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

Description below image.

Introduction (continued)

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

Slide 4

Description below image.

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

Description below image.

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

Description below image.

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

Description below image.

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

Description below image.

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

Description below image.

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

Description below image.

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

Description below image.

Domain and ItemsLong-stay surveyShort-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

Description below image.

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.

Slide 13

Description below image.

Q1. How Was the Food at the Nursing Home?

Image: A bar graph presents the following results to the question above:

ResponsePercent
01%
12%
22%
34%
45%
59%
613%
715%
819%
917%
1013%

Slide 14

Description below image.

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:

ResponsePercent
00%
12%
22%
34%
44%
58%
611%
715%
823%
912%
1020%

Slide 15

Q4. What Number Would You Use to Rate How Comfortable the Temperature Was in the Nursing Home?

Description below image.

Image: A bar graph presents the following results to the question above:

ResponsePercent
00%
11%
21%
30%
42%
57%
66%
78%
823%
926%
1026%

Slide 16

Description below image.

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:

ResponsePercent
00%
10%
21%
31%
41%
54%
67%
715%
826%
921%
1023%

Slide 17

Description below image.

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:

ResponsePercent
01%
10%
21%
33%
42%
55%
65%
710%
823%
925%
1026%

Slide 18

Description below image.

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:

ResponsePercent
00%
10%
20%
31%
41%
54%
61%
77%
816%
925%
1045%

Slide 19

Description below image.

Q20. What Number Would You Use to Rate the Nursing Home?

Image: A bar graph presents the following results to the question above:

ResponsePercent
00%
10%
20%
31%
41%
52%
63%
77%
818%
924%
1044%

Slide 20

Description below image.

Q39. Would You Recommend the Nursing Home to Others?

Image: A bar graph presents the following results to the question above:

ResponsePercent
Probably No3%
Definitely No3%
Probably Yes16%
Definitely Yes79%

Slide 21

Description below image.

Item/DomainPrimary Factor LoadingsMissing responsesFloorCeilingMeanStandard deviationItem-scale correlationCronbach's alpha coefficients
Meals       0.82
Q1. What number would you use to rate the food at the nursing home?0.761.4%1.1%22.4%8.002.400.61 
Comfort and Cleanliness       0.83
Q4. What number would you use to rate how comfortable the temperature was in the nursing home?0.702.2%2.9%19.1%6.982.750.69 
Safety and Security       0.76
Q6. What number would you use to describe how safe and secure you felt in the nursing home?0.711.7%1.8%24.6%7.832.52  
Medication and Pain Management0.662.4%1.1%23.1%7.732.540.530.81
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?0.721.9%1.1%21.3%7.092.580.48 
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?0.673.4%0.7%26.2%7.632.460.59 
Services       0.80
Q18. When you were in the nursing home, did you have any special therapy, such as physical, occupational, or speech therapy?0.622.6%1.7%23.7%8.382.010.60 
Nursing Home Environment       0.86
Q21. When you were in the nursing home, was the area around your room quiet at night?0.701.2%0.4%18.4%6.982.590.63 
Visitors       0.75
Q23. When you were in the nursing home, did you have any visitors?0.763.2%1.4%19.8%7.482.440.63 
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?0.711.2%3.8%19.5%7.182.340.52 
Autonomy       0.74
Q32. When you were in the nursing home, did the staff help you dress, take a shower, or bathe?0.721.9%1.1%21.3%7.092.580.48 
Leaving the Nursing Home       0.71
Q45. What number would you use to rate how well your discharge needs were met?0.731.8%2.4%22.9%7.722.410.57 

Slide 22

Description below image.

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.
  • Transition items:
    • Seem to perform well.
Page last reviewed March 2012
Internet Citation: CAHPS® Nursing Home Survey: Discharged Resident (Text Version). March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/castle/index.html