Implementing CG-CAHPS: Issues and Strategies (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 18, 2011, Dale Shaller made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (470 KB). Plugin Software Help.


Slide 1

Implementing CG-CAHPS: Issues and Strategies

Implementing CG-CAHPS: Issues and Strategies

Dale Shaller, MPA
Shaller Consulting Group

September 18, 2011

Slide 2

Forces Driving Use of CG-CAHPS

Forces Driving Use of CG-CAHPS

  • Public Reporting:
    • AF4Q and CVE initiatives.
    • State mandates.
    • Possible use in PhysicianCompare.
  • ACOs and Value-Based Purchasing.
  • Patient-Centered Medical Home.
  • HRSA Bureau of Primary Health Care.
  • American Board of Medical Specialties.
  • Rising consumer and patient expectations.

Slide 3

Profile of CG-CAHPS Users

Profile of CG-CAHPS Users

12-Month Version

  • Public reporting initiatives in CA, MA, and other markets.
  • Some health plans and systems (CA, MI, WI, MA).
  • Medical home evaluations.
  • Department of Defense.

Visit Version

  • Public reporting initiatives in MN, WI, MI, ME, and other markets.
  • Growing numbers of medical practices (including UHC and 6 safety net clinics in CA).
  • Vendors such as Press Ganey, NRC, Avatar.
  • ABMS for MOC (Doctor Communication items).

Slide 4

CG-CAHPS Database Composition (as of December 2010)

CG-CAHPS Database Composition (as of December 2010)

CG-CAHPS VersionNumber of Practice SitesNumber of Respondents
Adult 12-month 4-pt23541,834
Adult 12-month 6-pt339180,588
Child 12-month 6-pt524,883
Adult Visit469103,442
Totals1,095330,747

Slide 5

Key Implementation Issues

Key Implementation Issues

  • Survey version.
  • Patient populations and languages.
  • Unit of sampling and reporting.
  • Source of sample frame.
  • Sample size.
  • Data collection mode.
  • Data aggregation, analysis, and reporting.

Slide 6

Survey Version

Survey Version

  • Selection of survey version driven by user objectives, e.g.:
    • Internal improvement.
    • External reporting.
  • 12-month version:
    • Works well for assessing experiences that transcend individual visits.
    • Commonly used for external reporting.
  • Visit version:
    • Preferred by many clinicians for internal improvement.

Slide 7

Patient Populations and Languages

Patient Populations and Languages

  • Primary/specialty care.
  • Adults/children.
  • Commercial/Medicaid/Medicare/Other.
  • Patients with chronic conditions.
  • English-speaking patients or other.

Slide 8

Patient Populations and Languages

Sampling and Reporting Unit

  • Units of sampling and reporting include:
    • Individual clinician.
    • Clinic or practice site.
    • Medical group or health system.
    • Community/state/region/other.
  • Sampling and reporting units are often not the same:
    • Users may sample at clinician level for internal use but report results externally at higher levels.

Slide 9

Sample Size

Sample Size

CAHPS guidelines:

  • 45 completes per provider.
  • 300 completes per medical group.
  • ~ 220 completes per practice site (based on MN pilot).
  • New estimates for site-level samples are under development.

NCQA recommendations for PCMH survey at site level:

Number of CliniciansNumber of
Completed Surveys
145
2-360
4-9120
10-13150
14-19175
20-28225
29 or more clinicians240

Slide 10

Data Collection Modes: Outbound

Data Collection Modes: Outbound

  • Mail.
  • Telephone:
    • Landlines.
    • Cell phones.
  • Interactive Voice Response (IVR):
    • Touchtone IVR.
    • Speech-enabled IVR.
  • In-office distribution:
    • Paper survey.
    • Kiosk or other electronic modes.
  • E-mail distribution.

Slide 11

Field Period

Field Period

  • May depend on sampling method:
    • Continuous.
    • Point in time.
  • Same field period needed for comparability of results:
    • Ex: 3rd quarter of the year.

Slide 12

Regional Implementation Models

Regional Implementation Models

  • Centralized Model:
    • Single vendor.
    • Sample frame drawn from combined files of health plans or medical groups.
    • Examples: MHQP, PBGH, CHECKBOOK.
  • Decentralized Model:
    • Medical practices use their own vendors.
    • Integrate CG-CAHPS into current surveys.
    • Aggregation of multiple data sets through a neutral vehicle (CAHPS Database).
    • Examples: MN, Detroit, Maine, and WI.

Slide 13

Minnesota: Leveraged Model

Minnesota: Leveraged Model

  • 18 medical groups, 110 clinic sites.
  • 3 different vendors (PG, NRC, PRC).
  • Common administration protocol:
    • Sampling.
    • Administration (mail mode).
    • Field period:
  • CAHPS Database merged files and produced clinic-level results for reporting.

Slide 14

Massachusetts: Centralized Model

Massachusetts: Centralized Model

  • Over 500 practice sites.
  • Single vendor financed by health plans.
  • Results reported privately to systems, then publicly (every two years).
  • Systems collect own data internally more frequently, using same or different survey instruments.

Slide 15

Implementation Models: Pros and Cons

Implementation Models: Pros and Cons

ModelProsCons
Centralized
  • Uniform control of sampling and data collection.
  • May cover small practices with no vendor.
  • Potential economics of scale.
  • Sample frame does not include all patients.
  • May limit practices' use of data for QI.
  • Less sustainable financially.
Leveraged
  • Sample frame can include all patients.
  • Can build cost into current operations and budgets of practice.
  • Direct participation my foster greater use of QI.
  • Smaller practices may not have vendors.
  • Significant coordination needed to assure comparable sampling and administration.

Slide 16

Challenges Ahead

Challenges Ahead

  • Reconciling multiple survey requirements:
    • Internal improvement.
    • External reporting.
  • Reducing cost of implementation to achieve sustainable business models:
    • Using one survey and administration for multiple requirements.
    • Lowering administration costs through new data collection technologies.
Page last reviewed March 2012
Internet Citation: Implementing CG-CAHPS: Issues and Strategies (Text Version). March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/shaller/index.html