Assessing Patient-Centered Medical Homes from the Patient Perspective:

Developing the CAHPS® Clinician & Group PCMH Survey

Slide presentation from the AHRQ 2011 conference.

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.


Slide 1

 Assessing Patient-Centered Medical Homes from the Patient Perspective: Developing the CAHPS® Clinician and Group PCMH Survey

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  

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).

Slide 3

 The CAHPS Family of Surveys

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

Slide 4

Collaboration with NCQA

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.

Slide 5

CAHPS Design Principles

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.

Slide 6

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

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.

Slide 7

Overview of CAHPS CandG PCMH Surveys

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".

Slide 8

NCQA's PCMH 2011 Recognition Program

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.

Slide 9

Overview of Development Process

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.

Slide 10

CAHPS CandG PCMH Survey Domains

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.

Slide 11

Example of Item Development Issues #1

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.

Slide 12

Example of Item Development Issues #2

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.

Slide 13

CAHPS CandG PCMH Survey Reporting: CandG Core + PCMH Measures (Slide 1)

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 ...}

Slide 14

CAHPS CandG PCMH Survey Reporting: CandG Core + PCMH Measures (Slide 2)

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).

Slide 15

Public Release


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.

Slide 16

CAHPS User Network Resources

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.

Slide 17

CAHPS User Network

CAHPS User Network

Slide 18

Thank you!

  • Thank you!

Slide 19

Reference Slides

Reference Slides

Slide 20

Recommended Modes of Data Collection

Recommended Modes of Data Collection

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

Slide 21

Overview of Adult Instrument

Overview of Adult Instrument

DomainC&G Core Item CountPCMH Item CountC&G Core + PCMH Item Count
Access to Care9312
Communication718
Comprehensiveness033
Office Staff202
Self Management Support022
Shared Decision Making044
Coordination of Care246
Information about Care & Appointments033
Overall Rating101
Eligibility404
Demographics909
Total Item Count342154

Slide 22

Overview of Pediatric Instrument

Overview of Pediatric Instrument

DomainC&G Core Item CountPCMH Item CountC&G Core + PCMH
Item Count
Access to Care9312
Communication14014
Comprehensiveness11011
Office Staff202
Self Management Support022
Coordination of Care246
Information about Care & Appointments033
Overall Rating101
Eligibility404
Demographics12012
Total Item Count551267

Slide 23

Overview of Survey Instruments

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.

Slide 24

Overview of Survey Instruments

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).

Slide 25

Overview of Survey Instruments

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.

Slide 26

Overview of Survey Instruments

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.

Slide 27

Overview of Survey Instruments

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.

Slide 28

Overview of Survey Instruments

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.

Slide 29

Overview of Survey Instruments

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.

Slide 30

Overview of Survey Instruments

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

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

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.

Slide 33

Overview of Survey Instruments

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.
Page last reviewed March 2012
Internet Citation: Assessing Patient-Centered Medical Homes from the Patient Perspective:: Developing the CAHPS® Clinician & Group PCMH Survey. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/gallagher/index.html