Development of the CAHPS Clinician & Group Survey

In 1999, the CAHPS research team 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, the CAHPS team developed a preliminary instrument known as the CAHPS Group Practices Survey (G-CAHPS). Over time, that survey evolved into the CAHPS Clinician & Group Survey.

Key Steps in the Survey Development Process

Input from key stakeholders. The development of the Clinician & Group Survey has been informed by a variety of key stakeholders, including accrediting bodies, major provider and health plan associations, purchasers, and consumer representatives. These stakeholders provided input through interviews, and participation in an Advisory Group that gave feedback 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). Many organizations also responded to requests for public comment through the Federal Register.

Cognitive testing. In the spring of 2005, the CAHPS team conducted 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 field test instrument that was further refined with feedback from the Advisory Group. Additional cognitive interviews were conducted in English and Spanish was completed in September 2005, followed by additional Spanish-language interviews.

Field testing. Over a two-year period, roughly 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.

Release of 1.0 version. In early 2007, AHRQ released the Clinician & Group Survey 1.0 with guidance on how to implement the survey. In July 2007, the National Quality Forum endorsed this survey as a measure of patient experience with ambulatory care. The survey was also endorsed by the Ambulatory Care Quality Alliance.

Development of New Versions

Updating of the Child Survey. 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. This instrument was developed and tested by the Center for Survey Research (CSR) at the University of Massachusetts Boston, which conducted this work under the aegis of Yale Medical School's Department of Epidemiology and Public Health with funding from 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.

Development and release of the 2.0 version. In response to feedback from users and other stakeholders, the CAHPS research team 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.
• 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".

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. 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.

Development and release of the 3.0 version. In response to input from survey users and stakeholders, AHRQ’s CAHPS team recommended several changes to the Clinician & Group 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 MB).
• 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.

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).

Development of the Visit Survey 4.0 (beta). With telehealth playing an increasingly important role in care delivery in both primary and specialty care settings in 2020, the CAHPS team recognized the need for a survey to assess patient care experiences regardless of the manner in which the visit took place. The CAHPS team began with a review of the literature and other surveys that assess patient experiences with telehealth. After gathering input from a range of experts and stakeholders, the team drafted a survey consisting of 23 patient experience questions.

The comprehensibility of the draft survey questions was tested in cognitive interviews with English- and Spanish-speaking patients who had a healthcare visit in the prior 3 months. The revision process resulted in the beta version of an instrument designed to measure patient experience with in-person, phone, and video visits in the ambulatory care setting.

This survey is a beta version because the testing process is not complete. While the CAHPS team has conducted testing of the wording, further testing, including field testing, will need to be done to assess the measurement properties of the survey.

Learn more about the evolution of the Clinician & Group Survey from Version 1.0 to 4.0.

Release of 3.1 version. In August 2021, AHRQ released the 3.1 version of the Clinician & Group Survey to address the rapid changes to healthcare delivery as a consequence of the COVID-19 pandemic. The CAHPS team made minor edits to the survey to ensure that respondents report about all synchronous healthcare they received (i.e., in person, by phone or by video).