Assessing Patient-Centered Medical Homes from the Patient Perspective:

On September 19, 2011, Trish Gallagher made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (780 KB). Plugin Software Help.

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Assessing Patient-Centered Medical Homes (PCMHs) from the Patient Perspective: Developing the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician & Group PCMH Survey

Patricia Gallagher, PhD

Center for Survey Research
University of Massachusetts Boston
Yale CAHPS Team

Slide 2

Current CAHPS® Consortium

• AHRQ.
• Grantees: RAND, Yale.
• CAHPS User Network: Westat.
• Other Government and Private Stakeholders: Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA).

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The CAHPS Family of Surveys

• Family of surveys: comprehensive and evolving.
• Patients evaluate their experiences with ambulatory and facility health care.
• All surveys are in the public domain.

Text above points to a text box circle:

CAHPS surveys ask about our experiences with...

• Ambulatory Care:
  • Clinicians and Medical Groups
  • Health plans
  • Behavioral health services
  • Dental plans
• Facilities:
  • Hospitals
  • Nursing homes
  • Dialysis facilities

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Collaboration with NCQA

• Increasing attention to patient engagement was a key driver in NCQA's update of its PCMH recognition program.
• NCQA conducted public comment to identify priorities for a PCMH survey.
• Then worked with the CAHPS team to develop and test items.

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CAHPS Design Principles

• Emphasis on patients:
  • What patients value with respect to the setting of care.
  • Aspects of care for which patients are the best or only source of information.
  • Extensive testing with patients and families.
• Reports and ratings about experiences.
• Standardization:
  • Questionnaires, data collection protocols, analysis, reporting.
• Multiple versions for diverse populations:
  • Adult; Child; English & Spanish versions.
• All CAHPS surveys and products are in the public domain.

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CAHPS Clinician & Group Survey: Patient-Centered Medical Home Version

Image showing: CAHPS Clinician & Group Core Questionnaire* + CAHPS PCMH Item Set = CAHPS C&G PCMH Survey

*NQF endorsed.

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Overview of CAHPS C&G PCMH Surveys

• Expanded CAHPS C&G PCMH Surveys are appropriate for all primary care practices (PCMH and non-PCMH).
• Versions for Adult and Pediatric Populations.
• Appropriate for general population.
• 12-month "look-back" period.
• Referent is "provider" or "provider's office".

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NCQA's PCMH 2011 Recognition Program

• More emphasis on patient-centered care.
• Use of patient surveys.
• Additional credit for using the CAHPS C&G PCMH Survey.
• NCQA also plans a separate distinction in Patient Experiences Reporting for PCMH practices that report the results of patient experiences surveys.

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Overview of Development Process

• Technical Expert Panels (CAHPS and NCQA).
• Literature review.
• Focus group feedback.
• Cognitive testing (English and Spanish).
• Draft survey for Field Test.
• NCQA Field Test (English).
• Psychometric analysis & Instrument refinement.
• NCQA Public Comment Period.
• Instrument Refinement.
• Public Release of C&G Survey with PCMH questions.

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CAHPS C&G PCMH Survey Domains

Clinician & Group

• Access to Care.
• Communication.
• Office Staff.

PCMH

• Comprehensiveness.
• Self Management Support.
• Shared Decision Making.
• Coordination of care.
• Information about Care and Appointments.

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Example of Item Development Issues #1

• PCMH Shared Decision Making Items:
  • Screen for eligible respondents.
  • Provider talked about reasons to take a medicine.
  • Provider talked about reasons not to take a medicine.
  • Provider asked what you thought was best for you regarding medicine.
• Notes:
  • Only in Adult questionnaire. Taking prescription meds more rare in Pediatric population; SDM items included as pediatric supplemental set.
  • Tested Shared Decision Making related to surgery but incidence was too low.

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Example of Item Development Issues #2

• PCMH Self Management Support Items:
  • Work with you to set specific goals for your health.
  • Ask you if there are things that make it hard for you to take care of your health.
• Notes:
  • PCMH Items are designed for a general population.
  • Supplemental Items in development for population with chronic conditions.

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CAHPS C&G PCMH Survey Reporting: C&G Core + PCMH Measures (Slide 1)

CAHPS C&G Core: Composite Measures

• Getting Timely Appointments, Care & Information (5 items).
• How Well Providers Communicate With Patients (6 items).
• Helpful, Courteous Office Staff (2 items).

Child Survey Only:

• Provider's attention to your child's growth & development (6).
• Provider's advice on keeping your child safe & healthy (5).

Provider Rating {PLUS ...}

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CAHPS C&G PCMH Survey Reporting: C&G Core + PCMH Measures (Slide 2)

PCMH Composite Measures.:

• Providers pay attention to your mental or emotional health
  (Adult only; 3 items).
• Providers support you in taking care of your own health
  (2 items).
• Providers discuss medication decisions
  (Adult only; 3 items).

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Public Release

• The expanded Clinician & Group 12-Month Survey with PCMH Items will soon be available for download on the new CAHPS Web site: www.cahps.ahrq.gov.
• Measuring Patients' Experiences with Medical Homes Using the CAHPS Patient-Centered Medical Home (PCMH) Item Set:
  • A free Webcast sponsored by the CAHPS User Network.
  • Thurs, November 3, 2011, 2-3:30 ET.

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CAHPS User Network Resources

Users of CAHPS survey products and results have access to free resources:

• CAHPS Clinician & Group Surveys and Instructions.
• CAHPS Database.
• Current information about CAHPS products.
• Educational conferences and webcasts.
• One-on-one technical assistance.

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CAHPS User Network

• Visit the CAHPS Web site: https://cahps.ahrq.gov.
• Call the Help Line: 1-800-492-9261.
• Write the Help Line: cahps1@ahrq.gov.

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• Thank you!

Slide 19

Reference Slides

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Recommended Modes of Data Collection

• Mail Questionnaires only.
• Telephone Interviews only.
• Mixed Mode Administration:
  • Mail + Telephone.
  • E-mail + Mail/Telephone.

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Overview of Adult Instrument

Slide 22

Overview of Pediatric Instrument

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Overview of Survey Instruments

Access to Care

• C&G Core:
  • Got appointment for urgent care as soon as needed.
  • Got appointment for check-up or routine care as soon as needed.
  • Got answer to medical question the same day you phoned provider's office.
  • Got answer to medical question as soon as you needed when phoned provider's office after hours.
  • Saw provider within 15 minutes of appointment time.
• PCMH Supplemental Items:
  • Got needed care on evenings, weekends, or holidays.
  • Days you had to wait for an appointment for urgent care.

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Overview of Survey Instruments

Communication:

• C&G Core:
  • Provider explained things in a way that was easy to understand.
  • Provider listened carefully.
  • Provider gave easy to understand instructions about taking care of health problems or concerns.
  • Provider seemed to know important information about your medical history.
  • Provider respected what you had to say.
  • Provider spent enough time with you.
• PCMH Supplemental Items:
  • Provider knew you as a person (Adult only).

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Overview of Survey Instruments

Communication
Pediatric only items:

• C&G Core:
  • Provider explained things in a way that was easy for child to understand.
  • Provider listened carefully to child.
  • Provider gave you enough information about what was discussed with child when you were not there.
  • Provider gave you enough information about needed follow-up for child's care.

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Overview of Survey Instruments

Comprehensiveness
Growth and Development—Pediatric only items:

• C&G Core:
  • Talked about child's learning ability.
  • Talked about behaviors that are normal for child at this age.
  • Talked about how your child's body is growing.
  • Talked about child's moods and emotions.
  • Talked about how child gets along with others.

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Overview of Survey Instruments

Comprehensiveness
Keeping Child Safe and Healthy—Pediatric only items:

• C&G Core:
  • Talked about things to do to keep child from getting injured.
  • Given information about keeping child from getting injured.
  • Talked about how much time child spends in front of a computer and TV.
  • Talked about food your child eats.
  • Talked about exercise your child gets.
  • Talked about if there were problems in household that might affect child.

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Overview of Survey Instruments

Comprehensiveness
Behavioral—Adult only items:

• PCMH Items:
  • Talked about personal or family problem/alcohol or drug use.
  • Talked about worry and stress in your life.
  • Talked about feeling sad or depressed.

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Overview of Survey Instruments

Office Staff:

• C&G Core:
  • Clerks and receptionists at this office were as helpful as you though they should be.
  • Clerks and receptionists at this office treated you with courtesy and respect.

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Overview of Survey Instruments

Self Management Support:

• PCMH Items:
  • Work with you to set specific goals for your health.
  • Ask you if there are things that make it hard for you to take care of your health.
• Notes:
  • PCMH Items are designed for a general population.
  • Supplemental Items in development for population with chronic conditions.

Slide 31

Overview of Survey Instruments

Shared Decision Making
Adult only items:

• PCMH Items:
  • Provider talked about reasons to take a medicine.
  • Provider talked about reasons not to take a medicine.
  • Provider asked what you thought was best for you regarding medicine.
• Notes:
  • Taking prescription meds more rare in Pediatric population; items included as pediatric supplemental.
  • Tested Shared Decision Making related to surgery but incidence was too low.

Slide 32

Overview of Survey Instruments

Coordination of Care:

• C&G Core:
  • Provider's office followed up to give you results of blood test, x-ray, or other test.
• PCMH Items:
  • Provider seemed informed and up-to-date about care you got from specialists.
  • Talked with you about your prescriptions.

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Overview of Survey Instruments

Information about Care & Appointments:

• PCMH Items:
  • Got information about what to do if you needed care on evenings, weekends, or holidays.
  • Received reminders between visits.