CAHPS Patient Narrative Elicitation Protocol

The CAHPS® Narrative Elicitation Protocol (beta version) is a set of open-ended questions that prompt survey respondents to tell a clear and comprehensive story about their experience with a health care provider. Narratives from patients about their health care experiences can provide a valuable complement to standardized survey scores, both to help clinicians understand what they can do to improve their care and to engage and inform patients about differences among providers.

These supplemental items are designed to be used with the CAHPS Clinician & Group Survey.

They are available in English and Spanish for both the Adult and Child versions of the survey.

Questions in the Elicitation Protocol

The beta version of the Elicitation Protocol consists of five questions that are intended to be asked sequentially. The first question asks respondents to say what they are looking for in a health care provider and his or her staff. The second question asks the respondent to comment on the provider and his or her staff vis-à-vis those characteristics. The third and fourth questions ask the respondent to elaborate on what went well or could have been better. The fifth question asks about the relationship between the patient and the provider. In the Child version of the Elicitation Protocol, the fifth question asks specifically about the parent and provider’s relationship; a sixth question asks about the relationship between the child and the provider.

About the CAHPS Patient Narrative Elicitation Protocol (PDF, 478 KB) provides the beta version of these survey items as well as initial guidance on how to use them with the CAHPS Clinician & Group Survey.

Because of the sequential design of the questions, they are meant to be used together in the order specified. The CAHPS team does not recommend pulling out one or more of the questions for partial use or reordering the questions.

Brief History

In 2012, AHRQ began supporting research on eliciting patients' comments about their care through two grants: CAHPS IV and Building the Science of Public Reporting. The goal of this work has been to develop a method for collecting patient narratives that is as scientifically grounded and rigorous as the CAHPS closed-ended questions that are used to gather standardized data on patient experience. To that end, the CAHPS team created a set of open-ended questions that results in comments that meet the key criteria of being complete, balanced, meaningful, and representative.

Researchers affiliated with the Yale School of Public Health, RAND, and the University of Wisconsin-Madison worked collaboratively to develop and test open-ended survey items that could be incorporated into the CAHPS Clinician & Group Survey. The beta version of the Elicitation Protocol represents the results of this innovative research.

Learn more about the Development of the CAHPS Patient Narrative Elicitation Protocol.

For additional information, refer to:

  • Grob R, Schlesinger M, Parker AM, et al. Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives. Health Serv Res 2016 Jun;51 Suppl 2:1248–72.
  • Schlesinger M, Grob R, Shaller D, et al. Taking Patients’ Narratives about Clinicians from Anecdote to Science. N Engl J Med 2015 Aug;373(7):675–679.
Page last reviewed August 2017
Page originally created December 2016
Internet Citation: CAHPS Patient Narrative Elicitation Protocol. Content last reviewed August 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/surveys-guidance/item-sets/elicitation/index.html