Use of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surveys in Assessing the Patient-Centeredness of Cancer Care: NCI-AHRQ-CMS Collaborations

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Slide 1

Use of CAHPS Surveys in Assessing the Patient-Centeredness of Cancer Care: NCI-AHRQ-CMS Collaborations

Neeraj K. Arora, Ph.D.
National Cancer Institute (NCI),
Bethesda, MD

Presented at AHRQ's Annual Conference, Bethesda, MD, September 10, 2012

Slide 2

Why Patient-Centeredness?

Medical Care System

Slide 3

Diagnosis Cancer!!

• When dxed with cancer, patients are faced with two important questions...
  • What is going to happen to me? (fear)
  • Will I get care from a health care system that will help me through this crisis? (support)

Slide 4

Patient-Centered Care

Patient needs for ongoing support:

Informational support: Understand information.
Decisionmaking support: Make informed decisions.
Emotional support: Adjust to/cope with illness.
Appraisal support: Deal with uncertainty.
Instrumental support: Navigate the health care system and coordinate care.
Self-management support: Take care of health outside the healthcare interaction.

Slide 5

NCI Research Policy

• NCI supports research focused on facilitating the measurement, monitoring, and improvement of patient-centered cancer care with an aim to minimize the cancer burden.
• An area of emphasis: communication between patients/family and members of health care delivery teams.

http://outcomes.cancer.gov/areas/pcc

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NCI Collaborations

• Cancer CAHPS Survey: Collaboration with AHRQ (2009-2012):
  • Developed and pilot tested a cancer version of the CAHPS survey to measure patient experiences with care while receiving surgery, chemotherapy, or radiation.
  • Contract led by Dr. Steven Garfinkel at the American Institutes for Research and Dr. Kathleen Yost at the Mayo Clinic.
• SEER-CAHPS Data Linkage Project: Collaboration with CMS (2009-present).

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SEER-CAHPS Sponsors

• National Cancer Institute (NCI) & SEER registries.
• Centers for Medicare & Medicaid Services (CMS).

With technical assistance from:

• RTI International.
• Information Management Services, Inc. (IMS).
• RAND Corporation (Dr. Ron Hays), Harvard Medical School (Dr. Alan Zaslavsky).

Images: Logos of NCI, CMS, RTI International, and IMS are shown.

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SEER-CAHPS Data Sources

• SEER-CAHPS dataset includes the following:
  • Patient experiences data from CAHPS surveys fielded annually by CMS in all Medicare fee-for-service and Medicare Advantage plans from 1998-2010.
  • Clinical data from NCI's SEER registries for CAHPS respondents who had cancer while living in a SEER region (SEER covers ~28% of U.S. population).
  • Medicare claims data for CAHPS FFS respondents who had cancer and those without cancer who lived in a SEER region at the time of the survey.

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SEER-CAHPS Linkage: 1998-2010

Image: A box contains the text "Total Sample, 3,383,661." Two arrows point down from this box to two below it; one reads "Cancer Cases, 166,379" and the other box reads "Non-Cancer Cases, 3,217,282."

Slide 10

SEER-CAHPS Linkage: 1998-2010

Image: The three text boxes shown in Slide 9 are repeated. Two arrows below "Non-Cancer Cases, 3,217,282" point to two boxes; one reads "In SEER Region, 630,231" and the other box reads "Not in SEER, 2,587,051."

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SEER-CAHPS Linkage: 1998-2010

Image: The text boxes shown in Slide 10 are repeated. Two arrows below "Non-Cancer Cases, 166,379" point to two boxes; one reads "FFS, 53,170" and the other box reads "MA, 113,209." Two arrows below "In SEER Region, 630,231" point to two boxes; one reads "FFS, 213,454" and the other box reads "MA, 416,777." Two arrows below "Not in SEER, 2,587,051" point to two boxes; one reads "FFS, 1,009,580" and the other box reads "MA, 1,577,471."

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Potential Research Questions

• Do perceptions of care differ among patients with versus without cancer?
• To what extent do cancer patients' care experiences vary by racial and ethnic groups?
  • Do these disparities vary by FFS or Managed Care?
• How are patient experiences with care associated with utilization of care for beneficiaries in FFS plans?

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Progress to Date

• Linkage between SEER-CAHPS-Medicare claims completed:
  • Claims extracted for FFS beneficiaries for 2000-2010.
• CAHPS survey data being cleaned.
• Technical report on the data linkage activities and data codebook developed:
  • Overview manuscript describing the SEER-CAHPS dataset drafted.
• Work on initial empirical manuscripts begun.