Principles Underlying CAHPS Surveys

To ensure standardization and ease of use, the survey development teams follow several principles that underlie all CAHPS survey products.

Emphasis on Consumers and Patients

CAHPS surveys focus on aspects of care that meet two criteria:

  • The people who received care are the best and/or only source of the information. CAHPS surveys do not attempt to collect information that can be gathered more effectively through other means (e.g., through medical records or from physicians).
  • Consumers and patients identified the information as important to them. The CAHPS program devotes substantial resources to identifying and confirming issues that are salient to health care consumers and influence their decisions.

Reporting on Actual Experiences

While CAHPS surveys are similar to patient satisfaction surveys, they are not the same. As with satisfaction surveys, CAHPS surveys can include ratings of health plans or providers (such as doctors, hospitals, and nursing homes). But they go beyond ratings by asking patients to report on their experiences with health care services. Reports about care are regarded as more specific, actionable, understandable, and objective than general ratings alone.

Standardization Across the Board

In order to support valid comparisons and benchmarking across health care settings and over time, all CAHPS surveys are standardized in the following aspects:

  • The instrument. The contents and format of survey instruments are standardized so that everyone administering the survey is asking the same questions in the same way.
  • The protocol. The protocols for fielding the survey are standardized so that everyone adopts the same approach to drawing the sample, communicating with potential respondents, and collecting the data. This is important because the method of survey administration can affect the data.
  • The analysis. CAHPS surveys include a set of analysis programs and instructions to minimize variations in how sponsors and vendors process and interpret the results of the surveys.
  • The reporting. CAHPS surveys benefit from a well-tested approach to presenting survey results. Users of survey results have access to reporting measures as well as guidelines that reflect "best practices" in reporting.

Having all survey sponsors follow the same guidelines ensures that any survey sponsor's results are comparable to those of other sponsors. This comparability is what makes the information useful for quality improvement as well as public reporting.

Access to Benchmarks

To facilitate the use of CAHPS survey results, the Agency for Healthcare Research and Quality (AHRQ) has supported the CAHPS Database since 1997. The CAHPS Database enables participating sponsors to compare their results with those of their peers at local, regional, and national levels. Sponsors can also use the benchmarks derived from the data to evaluate and set objectives for performance improvements. Go to the CAHPS Database.

Applicability Across Heterogeneous Populations

All CAHPS survey products are developed with an eye towards making them useful for various segments, particularly vulnerable populations. The CAHPS Health Plan Survey, for example, was designed to be administered to people with any types of coverage, including Medicaid, Medicare, and commercial insurance, and across the full range of delivery systems. The Health Plan Survey can also capture information about the experiences of special groups, including children and adults with chronic conditions and disabilities.

Extensive Testing With Consumers

The CAHPS Consortium subjects all survey instruments to testing with members of the target population. As part of the cognitive testing process, the CAHPS Consortium tests the wording and formatting of survey instruments to maximize comprehension and usability. Findings from this testing contribute to improvements in question wording and navigation. In addition, extensive field testing ensures that survey administration guidelines and protocols are based on sound evidence.

Meaningful Information

To ensure that the surveys generate information that is meaningful to consumers and other audiences, reporting measures and their labels are developed in conjunction with the survey instruments.

Input From All Affected Parties

The survey development process includes frequent opportunities for major stakeholders, including clinicians, administrators, and accrediting bodies, to learn about the instrument and provide feedback.

Public Resource

All CAHPS products, resources, and services are in the public domain. Technical assistance, including general guidance as well as project-specific advice, is available to all users at no charge through the CAHPS Help Line ( or 1-800-492-9261).


Page last reviewed March 2016
Page originally created September 2013
Internet Citation: Principles Underlying CAHPS Surveys. Content last reviewed March 2016. Agency for Healthcare Research and Quality, Rockville, MD.