Development of the CAHPS Child Hospital Survey
The Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP) identified the need for a standardized survey to assess the experiences of pediatric patients and their families with inpatient hospital care. Consequently, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) funded the Center of Excellence for Pediatric Quality Measurement at Boston Children’s Hospital (CEPQM) to develop and test a CAHPS Hospital Survey for children. CEPQM pursued this effort with the same emphasis on standardization and scientific rigor that characterize all CAHPS products and surveys.
The Child Hospital Survey went through the following development process:
Literature review. The survey development team conducted a comprehensive review of existing patient experience measures and literature on experience of care for pediatric and adult inpatients.
Expert interviews and public commentary. Members of the survey development team conducted interviews with stakeholders, expert academic researchers, industry leaders, and potential end-users to solicit input on important aspects to consider when evaluating pediatric inpatient experience of care. Additionally, AHRQ submitted a Federal Register Notice (FRN) to solicit public comments for potential items and domains to include in the survey.
Focus groups. Based on findings from literature reviews, expert interviews, and public comments from the FRN, the team developed protocols for focus groups with recently hospitalized adolescents and parents of recently hospitalized children to ask about experiences with pediatric inpatient care. Incorporating focus group findings with prior research, the team identified key dimensions of pediatric inpatient care quality. Using these dimensions, the team drafted an initial survey instrument.
Cognitive testing. The team conducted 109 in-depth cognitive interviews in Boston, Los Angeles, Miami, and St. Louis in English and Spanish. The survey developers revised the instrument in response to findings from the interviews, resulting in a 78-item questionnaire used for pilot testing.
Pilot testing. In the summer of 2012, the survey development team conducted a pilot test of the draft survey in English and Spanish in eight hospitals across the country. Further survey revision and cognitive interviews led to a 66-item revised draft instrument.
Field testing. In 2013, the survey development team tested the revised draft instrument with parents of recently hospitalized children in 69 hospitals across 34 states. The survey was fielded in both English and Spanish by either mail or phone. Based on comprehensive psychometric analyses of the field test data, the survey team made revisions to the questionnaire.
End-user testing. In the winter of 2013, the survey development team conducted 23 cognitive interviews with parents in Atlanta and the Washington, D.C., area to test the understandability and usefulness of preliminary composite measure concepts and labels. Based on the findings from these interviews, the team refined the list of 18 composite, individual item, and rating measures and modified their labels.
Public release. The final Child HCAHPS Survey of 62 items was submitted to the CHIPRA Pediatric Quality Measures Program in early 2014. AHRQ released the survey and instructional documents for public use in mid-2014.