CAHPS®: 25 Years of Putting the Patient First

"Nothing about me, without me."

This adage—coined by a patient advocate in 1998—is the essence of patient-centered healthcare. It implies that every action in healthcare must be undertaken with the patient in mind, every decision made in consultation with the patient. It’s no surprise that the National Academy of Medicine (NAM) identifies patient-centeredness as one of the six aims of quality.

We are certain that 21^st Century Care means patient-centered care, and that cannot be achieved without a deep understanding of where the patient is in the care process. Clinical teams must see what patients see and hear what they hear. We know that the best way to find out if patients are at the center of the care process is to ask them.

This is why the AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Program is so important. The CAHPS Program, which turns 25 years old this week, is the Nation’s gold standard for understanding patients’ care experiences.

In October 1995, AHRQ’s predecessor, the Agency for Health Care Policy and Research, developed the first CAHPS survey to help advance quality measurement standardization. The CAHPS Program leveraged groundbreaking work on patient experience by the Picker Institute to include reports in addition to ratings of patient care.

This was important, because CAHPS surveys asked about experience—such as whether patients were spoken to respectfully and in a manner that they could understand—rather than satisfaction, which relied on patients’ feelings and expectations about their care. In doing so, CAHPS survey responses provided an objective measure of what actually happened to patients from their perspective. And, importantly, CAHPS surveys ask patients questions for which they are the best, or sometimes the only source of the information.

And, critically, the surveys were based on what patients told us was important to measure. They were designed with patient input from the very beginning. The surveys also reflected the needs of the system, as industry stakeholders were important contributors to survey development.

The new survey was statistically valid and reliable. The first CAHPS survey bore the hallmark of what became the program’s calling card: it was based on sound science. It was tested extensively with the very patients whose voices it was trying to capture. It was the first survey to put patients at the center of the process.

The CAHPS Program marked the Agency’s initial foray into patient-centeredness and became the cornerstone of AHRQ’s efforts to put patients at the center of every healthcare discussion. Other important patient-focused endeavors—including the Questions Are The Answer campaign and its associated QuestionBuilder mobile app, as well as numerous efforts around Patient-Reported Outcomes— have followed.

Over time, more CAHPS surveys were developed. The CAHPS Program started with a survey to measure beneficiaries’ experience with health plans and now also covers patients’ experiences with hospitals, other healthcare facilities, medical groups and providers, and specific conditions. Later, accumulated results gave patients a way to compare institutions with each other on this domain of healthcare quality.

Today, CAHPS surveys are sophisticated, scientifically valid measurement instruments that ask patients about various aspects of their treatment experience. For instance, Hospital CAHPS is composed of 29 items, encompassing aspects of the hospital experience such as communication with doctors and nurses, discharge information, and the cleanliness and quiet of the hospital environment.

Results are reported in the aggregate in a variety of State and Federal public reporting programs and in accreditation programs, making CAHPS surveys’impact apparent across the healthcare landscape. These surveys have forever changed the ways in which the patient’s voice is considered.

We are pleased to report that the CAHPS Program is still growing. Late this month, in response to the COVID-19 pandemic, AHRQ will release a survey that providers can use to assess patients’ experience with any format of ambulatory care visit, including telehealth. We  very recently introduced the CAHPS Emergency Department Survey. We are also developing a series of questions to elicit narrative information, so CAHPS surveys can capture patients’ experience in their own words.

This growth of the CAHPS Program comes within the context of our renewed commitment to patient-centeredness as the foundation of 21^st Century Care. We have demonstrated that 21^st Century Care must be technologically advanced, nimble to respond to emerging health threats, and laser-focused on safety. Patient-centeredness underpins all of this work and will ensure that the U.S. healthcare system remains a world leader for decades to come.

At AHRQ, we understand that cures and care are two sides of the same coin. But ultimately, high-quality care is about what patients need and want. So we hope you’ll join us in wishing the CAHPS Program a happy anniversary, and here’s to 25 more years!

Mr. Gopal Khanna is Director of AHRQ. Dr. Ginsberg is Director of AHRQ’s CAHPS Program

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