Development of the CAHPS Clinician & Group Survey
Dating back to the first phase of the CAHPS program (1996-2000), the CAHPS Consortium has recognized the need for a standardized, evidence-based instrument that would enable clinicians and administrators to assess and improve patients' experiences with their care. In 1999, they began work on a survey that would assess patients' experiences with medical groups and clinicians. Working in collaboration with the Pacific Business Group on Health, whose Consumer Assessment Survey established a precedent for this type of instrument, the Consortium developed a preliminary instrument known as the CAHPS Group Practices Survey (G-CAHPS).
Input From Key Stakeholders
One of the driving principles behind the CAHPS program has been close collaboration with key stakeholders, including accrediting bodies, major provider and health plan associations, purchasers, and consumer representatives. When the CAHPS II program began, the grantees sought input from stakeholders in order to determine how best to proceed with a provider-level survey. They interviewed a variety of people about their experiences with the Health Plan Survey and their information needs with respect to both clinicians and groups. The insights gleaned from these interviews played a major role in shaping the development of what became known as the Ambulatory Care CAHPS (A-CAHPS) initiative, whose goal has been to broaden the program's focus to encompass multiple levels of ambulatory care.
A-CAHPS Advisory Group. To continue getting that kind of valuable input, the CAHPS Consortium established the A-CAHPS Advisory Group, which included members of organizations that work closely with medical groups and clinicians, such as the American Board of Medical Societies, the American Board of Internal Medicine, the American Medical Group Association, and the Medical Group Management Association. The A-CAHPS Advisory Group participated in the development process on an ongoing basis by providing input into both content issues (e.g., domains, topics within domains, item content, and response scales) as well as survey administration issues (e.g., telephone versus mail, sample sizes, frequency of surveys). This feedback helped to ensure that the survey results for each level of the health care system reflected functions that are truly under their control.
Ongoing Outreach to Sponsors, Users, and Consumer Organizations. The CAHPS Consortium took advantage of various opportunities to inform interested parties about the Clinician & Group Survey and elicit comments and questions to advance its development. These outreach vehicles included the CAHPS User Group Meeting in March 2006, Webcasts, newsletter articles, and requests for public comment through the Federal Register.
In the spring of 2005, the CAHPS team conducted one round of 29 English-language cognitive interviews in Massachusetts and California in order to gauge how potential respondents understand and interpret the survey questions. The results of those interviews informed the development of a May 2005 field test instrument. By August, that version was further refined to incorporate feedback from the A-CAHPS Advisory Group. A followup round of nine English-language cognitive interviews was completed in September 2005, followed by additional Spanish-language interviews.
On August 18, 2004, AHRQ issued a notice in the Federal Register inviting organizations to test a draft instrument. From 2004-2006, over a dozen organizations administered a version of the Clinician & Group Survey to patients, providing data on a host of different issues for the CAHPS team to analyze. These field test organizations were crucial partners in the evolution and development of the instrument, and provided critical data illuminating key aspects of survey design and administration.
Endorsement by the National Quality Forum
In July 2007, the National Quality Forum endorsed the 1.0 version of the CAHPS Clinician & Group Survey as a measure of patient experience with ambulatory care. The survey was also endorsed by the Ambulatory Care Quality Alliance.
In January 2015, NQF renewed its endorsement for version 2.0 of the CAHPS Clinician & Group Survey through its Person and Family Centered Care Measures maintenance process. Version 3.0 will be submitted for endorsement renewal during the next NQF maintenance process.
Updating of the Child Survey
In response to comments from the National Quality Forum during its review of the Child Survey, the Center for Survey Research (CSR) at the University of Massachusetts Boston developed and tested a revised version of the 12-Month Survey for children. This work was conducted under the aegis of Yale Medical School’s Department of Epidemiology and Public Health and funded by The Commonwealth Fund.
The survey instrument underwent a multi-stage development process, including focus groups, cognitive interviews, a telephone pretest, and a field test. CSR received stakeholder input from the American Board of Pediatrics as well as from parents and guardians through their participation in the focus groups and cognitive interviews.
In 2009, AHRQ released the Child Primary Care Questionnaire 2.0 (beta); in October 2011, it became known as the Child 12-Month Survey 2.0.
Development of New Versions
Development of the 2.0 version. In response to feedback from users and other stakeholders, the CAHPS Consortium continued survey development and testing in several areas. In addition to the work described above on an updated survey for children, the process included:
- The development and testing of a survey that asks about a single visit. Learn more: Development of the CAHPS Clinician & Group Visit Survey
- The development and testing of a survey that can be used to gather information on experiences in a patient-centered medical home. Learn more: Development of the Patient-Centered Medical Home (PCMH) Item Set.
- Cognitive testing of items that refer to "your provider" rather than "your doctor".
Changes to the core 12-Month Survey included the following:
- Questions refer to "your provider" rather than "your doctor." This change addressed the fact that many people receive care from non-physician providers such as nurse practitioners and physicians' assistants. Users of the survey have the option of changing the language in their own questionnaires back to "your doctor."
- The items designed to identify chronic condition were moved from the core survey to the supplemental item set.
- A few items had minor wording changes to improve consistency within and across CAHPS surveys.
The CAHPS team released the resulting Clinician & Group Survey 2.0 in October 2011. The shift from versions 1.0 to 2.0 did not affect the ability of survey users to assess trends in performance.
Development and release of the 3.0 version. In response to input from survey users and stakeholders, AHRQ’s CAHPS Consortium recommended several changes to the CAHPS Clinician & Group (CG-CAHPS) Survey and the Patient-Centered Medical Home (PCMH) Item Set in January 2015. The Agency sought comments on these proposed changes through a Federal Register Notice.
- For a description of the proposed changes, read: Proposed Changes to the CAHPS Clinician & Group Survey Jan. 2015 (PDF, 1,010 KB).
- For a summary of the responses to the proposed changes, read: Summary and Next Steps in Response to Federal Register Notice (FR Doc 2015-00767) (PDF, 345 KB).
Based on responses to the proposed changes and analyses of multiple data sets, the CAHPS team released the 3.0 version of the Clinician & Group Survey and the PCMH Item Set in July 2015.
Key changes to the survey include the following:
- One instrument, in contrast to the three instruments available for the 2.0 version.
- Use of a 6-month reference time period rather than a 12-month reference period.
- New and modified composite measures:
- New composite measure for "Care Coordination."
- Modified composite measure for "Access."
- Modified composite measure for "Communication."
- A modified Patient-Centered Medical Home Item Set.
- Shift of development and prevention items from the core Child Survey to the Patient-Centered Medical Home Item Set.
- Overall reduced length.
Learn more about the 3.0 version:
- Comparability of Results for the 2.0 and 3.0 Versions of the CAHPS Clinician & Group Survey (PDF, 198 KB).
- An Overview of Version 3.0 of the CAHPS Clinician & Group Survey (PDF, 395 KB).
- Introducing the New CAHPS Clinician & Group Survey 3.0 (Webcast; September 17, 2015).