CAHPS Item Sets for People with Mobility Impairments
The CAHPS Item Sets for People with Mobility Impairments ask patients who have mobility impairments about their experiences with care and services from health plans and doctors’ offices. Over 11.5 million American adults age 18-64 have a mobility impairment,1 typically stemming from conditions including arthritis, heart or lung problems, unmanaged diabetes or obesity, spinal cord injuries, stroke, and muscle or nerve conditions such as cerebral palsy, Parkinson's disease, or multiple sclerosis. Many of these adults simultaneously have vision, hearing, emotional, or thought-processing co-impairments.
Supplemental items for people with mobility impairments are available for two CAHPS surveys:
The purpose of these items is to enable survey sponsors to—
- Assess the health care experiences of health plan members or patients who have lower-limb mobility impairments.
- Compare their experiences to those of similar people receiving care from other health plans or medical practices and/or people without impairments in the same plan or practice.
- Determine where improvements in services are warranted to better serve enrollees and patients with these impairments.
Why Information About this Population Matters
Many persons with mobility impairments have a "thinner margin of health" and need a more complex array of services than people without mobility impairments. They may also need modified referral procedures and accommodations to obtain services such as accessible diagnostic equipment and clinics. By incorporating these supplemental items into the CAHPS Health Plan Survey or the CAHPS Clinician & Group Survey, sponsors such as State agencies, other purchasers, health plans, health systems, and medical groups can assess how well they are meeting those particular needs and where they could improve.
In addition, the medical and financial consequences of delayed access accumulate rapidly for people with mobility impairments, driving up overall costs. With the help of these survey items, health care administrators, employers and Medicaid programs can identify opportunities for system improvement that will benefit all consumers.
Topics Addressed by the Mobility Impairment Items
The Item Sets for People with Mobility Impairment ask about experiences of care that are important to this population. The questions in both item sets cover the following topics:
- Being examined on the examination table.
- Getting weighed at the doctor's office.
- Difficulty moving around the restroom.
- Pain.
- Fatigue.
The items designed for the Health Plan Survey also cover these topics:
- Getting physical and occupational therapy.
- Getting speech therapy.
- Getting mobility equipment repaired.
- Getting or replacing mobility equipment.
These items should be dispersed in specific sections of the survey so that items that address common topics are grouped together. For example, in the Health Plan Survey, questions that ask about experiences with a personal doctor should be placed with core items that ask about the personal doctor. This approach reduces the cognitive burden on respondents. Instructions for placing items in the core survey are provided with the items.
Please note that some items that are important to people with mobility impairments already exist as CAHPS core or supplemental items. An example would be items dealing with coordination of care. The PWMI Item Sets do not include any items or repeat topics areas that are already addressed in the Health Plan Survey or Clinician & Group Survey.
Gathering the Data for the Mobility Impairment Items
The CAHPS Team does not have a specific sampling strategy to recommend in order to oversample people who are more likely to identify themselves as having impaired mobility. Please follow the standard sampling protocol for the CAHPS survey you are fielding. Since many people with lower-limb mobility impairments also have impairments of the upper limb, the administrative mode you select (e.g., mail, telephone, mixed mode) may have an effect on responses.
Analyzing and Reporting the Data
The CAHPS Analysis Program (also known as the CAHPS macro) uses three identifier items (patient used mobility equipment, patient’s ability to walk a quarter mile, patient had difficulty or needed assistance walking a quarter mile) to identify the population of people with mobility impairments. Survey sponsors can then compare survey results for respondents with and without mobility impairments.
The CAHPS team suggests two ways of reporting the survey information back to health care providers, quality improvement teams, and administrators:
- To identify the ways in which the experiences and perceptions of respondents with and without mobility impairments differ as well as the ways in which they are consistent, report the standard CAHPS composites measures for two separate groups:
- The general population of respondents.
- The people identified as having mobility impairments.
- Report only the items for people with mobility impairments.
Development of the Mobility Impairment Items
The Agency for Healthcare Research and Quality’s CAHPS Consortium first released this item set for use with the CAHPS Health Plan Survey in 2007. The development process included input from a Technical Expert Panel, several rounds of cognitive testing, and field-testing in Massachusetts and Wisconsin.
A version designed for use with the CAHPS Clinician & Group Survey was released in 2017.
1. Steven AC, Carroll DD, Courtney-Long EA, et al. Adults with One or More Functional Disabilities—United States, 2011-2014. Morbidity and Mortality Weekly Report. 2016, Sept. 30. 65(38);1021-1025
