Pain Items in the CAHPS Adult Hospital Survey

The Adult version of the CAHPS® Hospital Survey (HCAHPS) asks discharged patients questions about their recent hospital stay. The questions in the survey focus on important aspects of patients' hospital experiences, including communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, communication about medicines, and discharge information.

The survey also includes questions asking about pain control. These questions are included because 73% of patients report that needing medicine for pain and pain control is an appropriate part of routine hospital care. Furthermore, both patients interviewed as part of the survey development process and articles in the scientific literature indicated that inadequate pain management was a common problem. Pain management includes communicating with patients about pain-related issues, setting expectations about pain, shared decisionmaking, and proper prescription practices.

The three HCAHPS pain items are listed as follows:

12.    During this hospital stay, did you need medicine for pain? (Response options: Yes/No; if no, respondent is directed to Question 15)

13.    During this hospital stay, how often was your pain well controlled? (Response options: Never/Sometimes/Usually/Always)

14.    During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? (Response options: Never/Sometimes/Usually/Always)

Maher et al. (2015) and Nota et al. (2015) found that less opioid use was associated with better CAHPS scores. Nonetheless, because of the perception of some providers that use of these items might lead to overprescribing pain medicine, these items are no longer used (as of fiscal year 2018) in Hospital Value-Based Purchasing. CMS, in conjunction with AHRQ’s CAHPS Consortium, is evaluating different pain control items for possible inclusion in future versions of the HCAHPS Survey.

Learn More

Goldstein E, Farquhar M, Crofton C, Darby C, Garfinkel S. Measuring hospital care from the patients' perspective: an overview of the CAHPS Hospital Survey development process. Health Serv Res. 2005 Dec;40(6 Pt 2):1977-95. PubMed PMID: 16316434; PubMed Central PMCID: PMC1361247.

Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine, 2001, National Academy of Sciences.

Levine RE, Fowler FJ Jr, Brown JA. Role of cognitive testing in the development of the CAHPS Hospital Survey. Health Serv Res. 2005 Dec;40(6 Pt 2):2037-56. PubMed PMID: 16316437; PubMed Central PMCID: PMC1361243.

Maher DP, Wong W, Woo P, Padilla C, Zhang X, Shamloo B, Rosner H, Wender R, Yumul R, Louy C. Perioperative factors associated with HCAHPS responses of 2,758 surgical patients. Pain Med. 2015 Apr;16(4):791-801. doi: 10.1111/pme.12651. Epub 2014 Dec 28. PubMed PMID: 25545695.

Nota SP, Spit SA, Voskuyl T, Bot AG, Hageman MG, Ring D. Opioid Use, Satisfaction, and Pain Intensity After Orthopedic Surgery. Psychosomatics. 2015 Sep-Oct;56(5):479-85. doi: 10.1016/j.psym.2014.09.003. Epub 2014 Sep 6. PubMed PMID: 25624183.

Page last reviewed June 2017
Page originally created June 2017
Internet Citation: Pain Items in the CAHPS Adult Hospital Survey. Content last reviewed June 2017. Agency for Healthcare Research and Quality, Rockville, MD.