Consumer Assessment Health Plan Survey: CAHPS®

Gathering patient experiences

Oktober 2004Barbara Vriens

Outline

• Instruments

• Construction

• Response

• Validation

• Key findings Hospitals and Diabetics

• Questions

Instruments (1): 2 Markets

Medical outcome Medical outcome

Quality of life Quality of life

Patiënt experience Patiënt experience

Innovative technologie Innovative technologie

HealthProvider

Health plan Customers

Instruments (2): CAHPS

• Consumer Assessment of Health Plans Survey, developed by the Agency for Healthcare Research and Quality (AHRQ) in the U.S.

• A CAHPS-questionnaire captures the experiences of patients with received care and experiences of customers with a health plan.

Instruments (3): developed june 2003 – june 2004

• Healthcare market

• Diabetics CAHPS-NL

• Hospital CAHPS-NL

• Health insurance market

• Commercial CAHPS-NL

Instruments (4): Items (experience, not satisfaction)

• Getting needed care• Getting care quickly• Courteous, respectful and helpful office staff • How well doctors & nurses communicate• Health plans customer service, information and

paperwork• Global ratings (nurses, doctors, hospital, health plan)• Patient/Consumer demographics• Quality of care (diabetic, i.e. group- cahps)

Construction (1): proces

CAHPS®:Adult Commercial QuestionnaireAdult MedicAid Managed CareAdult MedicAid Fee-for-ServiceSupplement Hospital CAHPS®

Selection of

questions

Translation US-Dutch

And Dutch-US

Choice of best

translation

Translate

and add extra

questions

Construction (2): proces

Extra questions were added in the following CAHPS:

• Commercial CAHPS-NL: questions about language spoken in order to see differences in non-Dutch origin and Dutch origin;

• Diabetics CAHPS-NL: QUOTE*-questions about specific diabetic-care (formulated in CAHPS structure).

* QUality Of care Through the patients’ Eyes. The Quote-Diabetes is developed by Nivel, 2000.

ResponseNumber of addresses

Crude response

Commercial CAHPS-NL

977 56%

Diabetic CAHPS-NL(Amsterdam)

983 57%

Hospital CAHPS-NL(2 hospitals)

1.996 66%

Validation: Key findings Commercial CAHPS-NL• Compares health insurance companies on

• Getting needed care• Getting care quickly• Courteous, respectful and helpful office staff • How well doctors & nurses communicate• Health plans customer service, information and paperwork• Global ratings (nurses, doctors, hospital, health plan)• Patient/Consumer demographics

• The translated questionnaire is found to be a useful instrument in the context of the Dutch healthcare system;

• A few questions should be adjusted to improve the questionnaire;

• Overall the new instrument was found to be valid and reliable.

Validation: Key findings Hospital CAHPS-NL• Seven factors relating to patient hospital experience were constructed:

• communication with doctor• communication with nurses• discharge information• communication about medication• pain control• physical environment• nursing services

• Communication with nurses had the strongest relationship with the global ratings for nurses and hospital and likelihood of recommending the hospital;

• Differences between the two hospitals can be pointed out as differences between quality

• Overall the new instrument was found to be valid and reliable;• The findings mirrored the results in the US and surveys in Dutch hospitals.

Experience hospital A and B (ill and healthy)

Hoe vaak goede uitleg door ...

1,0

1,5

2,0

2,5

3,0

3,5

4,0

v06-verpleegkundige v13-arts

Ziek Totaal Gezond

Experience (hospital A and B)

Hoe vaak goede uitleg door ...

1,0

1,5

2,0

2,5

3,0

3,5

4,0

v06-verpleegkundige v13-arts

Zkh A Totaal Zkh B

Population (hospital A and B)

Verhouding zieke / gezonde respondenten, per ziekenhuis

0%

10%

20%

30%

40%

50%

60%

Zkh A Totaal Zkh B

Gezond Ziek

New Medication and discharge experiences• Both hospitals have low outcome on new medication

• Purpose and name of the medicine• Co-medication• Side-effects• Allergic reactions

• Both hospitals have low outcome on discharge information• Information how to behave• Information about taking notice

Validation: Key findings Diabetes CAHPS-NL

• For a few aspects the findings mirrored other studies. There

are limited studies available to compare;

• Ratings of patients have a relationship with the period in witch

care was received (check of HbA1c, Cholesterol, blood

pressure, feet);

• A few questions should be adjusted;

• Overall the new instrument was found to be a valid and reliable

basis for further development.

Score losse vragen en composiet Communicatie,incl. betrouwbaarheidsinterval 95%

0%

25%

50%

75%

100%

vraag1 vraag2 vraag3 vraag4 composiet

Huisarts Internist Verpleegkundige Diëtist

Show respect Listening carefully Explain things Have enough time Total

Composiet scores Afstemming, Begeleiding, Communicatie en Voorkomendheid,

incl. betrouwbaarheidsinterval 95%

0%

25%

50%

75%

100%

Huisarts Internist Verpleegkundige Diëtist

Afstemming Begeleiding Communicatie Voorkomendheid

HbA1c CAHPS Diabcare

Lower dan 9 79% 87%

9 or higher 21% 13%

Blood pressure CAHPS Diabcare

Lower dan 90 74% 80%

90 or higher 26% 20%

     

Lower dan 140 47% 45%

140 or higher 53% 55%

Outcome

  CAHPS Diabcare

Eye controle 70% 68%

Feet controle 60% 65%

Urine controle 60% 82%

Blood pressure 90% 92%

HbA1c 87% 87%

Process

 parameter proces Uitkomsten Punten

HbA1c(Long term suger)

93% of the patients had their HbA1c measured in the last 12 months

55% < 8%≤ 21% ≥ 9,5%

510

Lipid profile 85% of the patients had their lipid profile measured in the last 12 months

63% heeft LDL ≤ 130

mg/dl

20

Risc profile Of 90% of the patients the risk profile is known based on blood pressure, Hba1c and lipid profile

Improvement of 10%

40

parameter proces uitkomst bonus

Patient experience 90% is informed about HbA1c, blood pressure and life style

80% knows their own level of HbA1c, blood pressure and reproduces life style advise

20

afstemming(interaction between professionals)

  80% gets uniform information from the different health providers of goals to achieve

20

Questions?

Patiëntenervaringen Ziekenhuis

• Formule en deskundigheid in huis of toegankelijk voor Agis• Database eigendom van Agis

• Tevredenheid communicatie• Tevredenheid zorg• Tevredenheid specialistische zorg• Tevredenheid toegang

Patiëntenervaringen diabeteszorg

• Formule en deskundigheid in huis of toegankelijk voor Agis• Database eigendom van Agis

• Diabeteszorg algemeen 58% goed of hoger• Diabetesvragen beantwoord 56%• Toegang acute vraag 46%• Uitleg labresultaten 50%• Respect zorgverlener 70%

• internist, diabetesverpleegkundige, diëtist,huisarts