Slide Presentation by Dale Shaller, M.P.A.
On February 10, 2004, Dale Shaller, M.P.A., made a presentation in a Web Conference at Event 1, which was entitled "The Role of the NHQR and the NHDR in Improving the Quality of Health Care."
This is the text version of Mr. Shaller's slide presentation. Select to access the PowerPoint® slides (158 KB).
The CAHPS® Improvement Guide
Dale Shaller, M.P.A.
Principal, Shaller Consulting
Managing Director, National CAHPS® Benchmarking Database (NCBD)
Member, Harvard Medical School CAHPS® II Team
Slide 1
What is the CAHPS® Improvement Guide?
- A resource manual for health plans and medical groups seeking to improve their performance in domains measured by CAHPS®.
- Funded by CMS (Medicare).
- Developed by Harvard Medical School CAHPS® Team.
Slide also contains a small photo of the CAHPS® Improvement Guide.
Slide 2
What is CAHPS®?
- Most widely used survey tool for measuring the patient's perspective on quality.
- Funded by AHRQ and developed by the CAHPS® Consortium.
- CAHPS® Health Plan Survey assesses care in health plans covering over 125 million Americans.
- New CAHPS® surveys now under development for:
- Hospitals.
- Medical groups.
- Individual clinicians.
- New focus on helping plans and providers use CAHPS® for quality improvement.
Slide 3
Performance Domains Measured by the CAHPS® Health Plan Survey
Consumer Reports:
- Access
- Getting Needed Care.
- Getting Care Quickly.
- Interpersonal Care
- How Well Doctors Communicate.
- Courteous and Helpful Office Staff.
- Administrative Services
- Customer Service.
- Claims Processing.
Consumer Ratings:
- Overall Ratings
- Personal Doctor.
- Specialist.
- All Health Care.
- Health Plan.
Slide 4
A Guide to the CAHPS® QI Guidebook
This slide contains a series of ovals, text boxes and arrows that show how the CAHPS® QI Guidebook is laid out. In the top left hand corner of the slide is a text box that reads "Section 1. Setting the Stage: An Infrastructure that Supports Improved Performance" Directly under the first text box, and linked to it by a downward pointing arrow is a second that includes the content of the next section of the guidebook: "Section 2. Identifying Opportunities to Improve." Under the 2nd text box is another text box, again linked by a downward pointing arrow to the box above it, this 3rd text box reads "Section 3. Implementing the CAHPS ® Improvement Cycle." This cycle is depicted in an oval below the 3rd text box. At the top of the oval is the text:
Plan Strategy
- Create team (if needed).
- Establish/confirm goals.
- Investigate potential interventions (see Section 4).
An arced arrow pointing downward and to the right leads to the next step in the cycle:
Develop and Test Strategy
- Select measures to monitor progress.
- Develop changes using selected intervention.
- Conduct small tests of change.
- Adapt changes to org. context.
- Identify and deal with barriers.
Another arced arrow pointing downward and to the left leads to the third step:
Monitor Strategy
- Implement changes and hold the gains.
- Evaluate progress against criteria3.
Following the above text is an arced arrow that points upward and to the left. After this arrow is the text:
Reassess & Respond
- Use CAHPS® data to assess what worked, what didn't.
- Spread successful innovations."
Another arced arrow pointing upward and to the right closes the cycle.
An arrow pointing protruding from the middle of the Improvement Cycle oval, leads to a text box that reads: "Section 4. Ideas for Improving Experiences with Care" Under this text is a series of 6 boxes. Within those boxes the following text is listed, from left to right: Getting needed care; Getting care quickly; Doctors communicate well; Customer service; Claims Processing; and home health & preventive services.
Slide 5
Using CAHPS® to Identify Improvement Opportunities
In the top left corner of this slide there is a legend that is titled "Getting Needed Care." Below that text is a gray bar representing "A big problem," a white bar representing "A small problem," and a red bar representing "Not a problem."
To the right of the above legend is another. This shows that an upward pointing arrow represents "better than adult commercial distributions, (p<.005). Below that is a downward pointing arrow, meaning "worse than adult commercial distributions, (p<.005)."
Below the 2 legends, in a column on the left side of the slide is a list of categories. On the right hand side of the slide are corresponding percentages, in gray, white and red bars for each category. Those categories, their corresponding percentages-as shown by gray, white, and red bars respectively, and status as "better" or "worse" than adult commercial distributions, are as follow:
National Adult Commercial Results (n=105041)-8%, 18%, and 74%
HMO/POS Model Type Results (n=84728)- 8%, 19%, and 73% ?
PPO Model Type Results (n=20032) -5%, 16%, and 79% ?
Local Sponsor Market Results (n=5850) -8%, 18%, and 74%
Plan A (n=1713) -8%, 18%, and 75%
Plan B (n=542) -5%, 15%, and 80% ?
Plan C (n=405) -11%, 19%, and 70% ?
Plan D (n=495) -9%, 16%, and 75%
Plan E (n=544) -9%, 22%, and 68% ?
Slide 6
Using CAHPS® to Identify Improvement Opportunities
This slide contains a four-celled matrix. There is a text box linked to the upper left cell by an arrow. The text reads: "Top Priority Low achievement scores on composites highly correlated with rating of overall health care." The upper right cell has the text "High Priority Already doing very well on composites highly correlated with rating of overall health care. Could try to do even better" linked to it. The lower left cell has the text "Medium Priority Low achievement scores on composites only slightly associated with rating of overall health care" associated with it. The lower right cell has the text "Low Priority Doing very well on composites items not highly correlated with rating of overall health care" linked to it. The horizontal axis of this grid has numbers 60-100 listed in 5 unit increments and these numbers represent "Achievement Scores," with a footnote explaining "An achievement score is ranked "high" when score is 85 or higher."
The vertical axis is labeled "Correlation with Rating of Overall Health Care," with a footnote explaining : "An association with Overall Health Care is ranked "high" when correlation is .4 or higher." The top of this axis is labeled "High," the bottom "Low" and a midpoint of "0.40."
Five symbols are located inside the matrix. The symbols, the concepts they represent, and their placement on the matrix are as follow:
Red Square = "Getting needed care." This symbol has an achievement score of roughly 92 and a correlation just below 0.40.
Blue Triangle = "Courteous and Helpful Office Staff" This symbol has an achievement score of roughly 94, and a correlation in the "low" range.
Yellow circle = " Getting Care Quickly" This symbol has an achievement score of roughly 82 and a correlation in the "low" range.
Green Star = "Customer Service" This symbol has an achievement score of about 89 and a correlation slightly above 0.40.
Purple Diamond = "How Well Doctors Communicate." This symbol has an achievement score of about 90 and a correlation right at 0.40.
Slide 7
CAHPS® Improvement Process Cycle
This slide contains a series of text and arrows all organized in a circle representing the CAHPS® Improvement Process Cycle. The starting point of this cycle is outlined by the text:
Plan Strategy
- Create team (if needed).
- Establish/confirm goals.
- Investigate potential interventions.
This first step is linked to the next by an arrow that points downward and to the right leading to the step:
Develop and Test Strategy
- Select measures to monitor progress.
- Develop changes using selected intervention.
- Conduct small tests of change.
- Adapt changes to organizational context.
- Identify and deal with barriers.
A downward and left pointing arrow links the previous step to the next:
Monitor Strategy
- Implement changes and hold the gains.
- Evaluate progress against criteria.
From that text, an upward and left pointing arrow leads to the text:
Reassess & Respond
- Use CAHPS® data to assess what worked, what didn't.
- Spread successful innovations.
A final arrow pointing upward and to the right completes the cycle.
Slide 8
Improvement Strategies
- Over 2 dozen strategies mapped to CAHPS® core questions.
- Apply to plan, medical group, or both.
- Each strategy includes:
- Problem description.
- The intervention and its benefits.
- Examples of implementation.
- Key resources.
Slide 9
Examples of Strategies for Improving Doctor Communication
- Physician training.
- Patient communication tools.
- Shared decisionmaking.
- Support groups and self-care.
- Delivery of evidence-based information.
- Planned visits.
- Group visits.
Slide 10
Distribution and Use of the Guide
- CMS sent print and CD-ROM versions to all Medicare managed care plans.
- CMS Web site and regional offices.
- CAHPS-SUN Web site: http://www.cahps-sun.org/WhatsNew/WhatsNew.asp.
- Meetings and conferences .
- CAHPS® QI demonstration projects
- Institute for Clinical Systems Improvement.
- Seeking feedback for future updates.
Current as of June 2004
Internet Citation:
The CAHPS® Improvement Guide. Text Version of a Slide Presentation at a Web Conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/qcount/shallertxt.htm
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