Survey Updates and Quality Improvement Resources

Julie A. Brown, RAND Corporation

AHRQ 2012 Annual Conference

Bethesda, MD

September 9, 2012

• Ambulatory Care Surveys

– CAHPS Clinician & Group (C&G) Survey– CAHPS Health Plan Survey– CAHPS Surgical Care Survey– ECHO® Survey– CAHPS Dental Plan Survey– CAHPS American Indian Survey– CAHPS Home Health Care Survey

• Facility Surveys

– CAHPS Hospital Survey (HCAHPS)– CAHPS In-Center Hemodialysis Survey– CAHPS Nursing Home Surveys

2

The CAHPS Family of Surveys

• Update existing surveys to reflect “best survey science”

• Began with core surveys– Health Plan version 5.0– Clinician & Group version 2.0– Surgical Care version 2.0– Working with stakeholders (e.g. CMS, NCQA)

• Working on supplemental items– CG-CAHPS Adult supplemental items available

Survey Review and Update

3

• Simplified Access items• Made access to specialist item consistent• Improved item on access to care, test, and

treatment• Made chronic condition identifying items

consistent• Added self-reported mental and emotional health

item

Health Plan Survey 5.0

4

• Access to urgent and non-urgent care asked about getting care “you thought you needed”– Removed “you thought”– Made consistent across CAHPS Surveys

• Non-urgent care items was defined as “not counting the times you needed care right away”– Updated to “a check up or routine care”– Made consistent across CAHPS Surveys

Simplified Access Items

5

• Specialist item asked “how often was it easy to get appointments with specialists”– Revised to “how often did you get an appointment to

see a specialist as soon as you needed”– Made consistent across CAHPS Surveys

Consistent Specialist Item

6

• Asked about ease of getting care, tests, and treatment you thought you needed through your health plan– Dropped “you thought”

• Consistency across surveys

– Dropped “through your health plan”– Moved from “Your Health Plan” section to “Your

Health Care in the Last 12 Months” section• Clarifies who is providing care, tests, or treatment• Screener item no longer needed• Consistent across surveys

Care, Tests, and Treatment Items

7

• Chronic condition identifying items standardized across CAHPS Surveys

• Initial screening item asked whether you saw a doctor or other health provider 3 or more times for the same problem or condition– Simplified to got health care 3 or more times for the

same problem or condition

• No changes to other items in the chronic condition identifier

Chronic Condition Identifiers

8

• Respondent rating of overall mental or emotional health

• Added after the overall health status rating• Powerful case-mix adjuster• Made consistent across surveys

Self-reported Mental or Emotional Health Item

9

• Changed how we refer to focal provider

• Made minor improvements to item wording

• Moved chronic condition screening items to supplemental items

• Added mental health item

• Finalized – Child 12-Month Survey – Adult Visit Survey

10

C&G Survey 2.0

• Updated to make consistent with CG-CAHPS Survey 2.0

• NQF endorsed in 2012

Surgical Care Survey 2.0

11

• Communicated to CMS– Plans to adopt for use in 2014

• NCQA adopted 5.0 core survey for use in 2013– Includes updated shared decision-making items– Other changes to HEDIS items (CAHPS supplemental items)

will be evaluated for the 2014 survey

Key Stakeholders

12

• CAHPS Surveys play an important role as a QI tool for organizations to use standardized data to:– Identify relative strengths and weaknesses in their

performance– Determine where they need to improve– Track their progress over time

Use of CAHPS Surveys for QI

13

• The CAHPS Improvement Guide• Reports and case studies• Supplemental items• Presentation slides and transcripts

14

QI Resources

• Comprehensive resource for health plans, medical groups, and other providers seeking to improve their performance in the domains of quality measured by CAHPS Surveys

• Use of the Guide can help organizations:– Cultivate an environment that encourages and sustains QI– Analyze the results of CAHPS Surveys to identify strengths

and weaknesses– Develop strategies for improving performance

The CAHPS Improvement Guide

15

• Why improve patient experience?• Are you ready to improve?• Analysis of CAHPS results• Quality improvement steps• Improvement interventions

Guide Content

16

• Case studies of quality improvement series• A Tale of Three Practices: How Medical Groups are

Improving the Patient Experience• In-Center Hemodialysis Quality Improvement Project• Profiles of High-Performing Family- and Patient-

Centered Academic Medical Centers• Go Guide – Transform Care in Six Steps• Patient-Centered Care: What Does It Take?• Providing Performance Feedback to Individual

Physicians

Reports and Case Studies

17

• Many of the supplemental items for the CAHPS Health Plan and Clinician & Group Surveys can help users to develop and monitor QI efforts in multiple areas of care.– Access and After Hours Care– Communication “drill down” – Care Coordination

Supplemental Items for QI

18

• User Group Meetings

• Webcasts

• Podcasts– QI podcast series

Presentation Slides and Transcripts

19

• Case for Improving Patient Experience• Creating an Improvement Culture• The Role of Leadership in QI Efforts• Teamwork in QI• Human Resources Issues• Qualitative Methods for Patient Experience• Identifying Areas to Improve• Improving Communication• Factors Affecting Care Coordination• Creating an Effective Customer Service Training Program• Tackling Low Literacy

QI Podcast Series

20

• Although the CAHPS Web site is temporarily changing, AHRQ’s support for CAHPS has not changed

• AHRQ will continue to offer technical assistance regarding the use of CAHPS products via telephone and email

Call: (301) 427-1017 E-mail: cahps1@ahrq.hhs.gov

CAHPS User Network

21