CAHPS Driven Quality Improvement: Primary Care

1. CAHPS Driven Quality Improvement: Primary Care Susan Edgman-Levitan,PA Executive Director Stoeckle Center for Primary Care Innovation Massachusetts General Hospital Co-PI, Yale/Harvard CAHPS Team

2. IFCC Core Concepts of Patient and Family-Centered Care • Dignity and Respect.Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. • Information Sharing.Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making.

3. IFCC Core Concepts of Patient and Family-Centered Care • Participation.Patients and families are encouraged and supported in participating in care and decision-making at the level they choose. • Collaboration.Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation; in facility design; and in professional education, as well as in the delivery of care.

4. Dimensions of Patient and Family-Centered Care • In addition to safe and technically excellent care, patients and families identify the following specific dimensions as the most critical aspects of the ambulatory care experience: • Access; • Respect for patients’ values and preferences; • Coordination of care; • Information, communication, and education; • Emotional support; • Involvement of friends and family;

5. Clinician-Group CAHPS and Patient and Family- Centered Care • Getting Appointments and Health Care When Needed • Access to information and appointments • Waiting times in the office and exam room • How Well Doctors Communicate • Respect for patient preferences • Clear and understandable information about diagnosis, treatments, and medications • Listening and empathy • Courteous and Helpful Office Staff • Respectful, helpful, and courteous office staff • Overall Rating

6. The CAHPS® Improvement Guide • A resource manual for health plans and medical groups seeking to improve their CAHPS® scores • Funded by CMS (Medicare) and developed by Harvard Medical School CAHPS® Team • Over 2 dozen strategies mapped to CAHPS® core questions

7. Section 1. Setting the Stage:An Infrastructure that Supports Improved Performance Section 2. Identifying Opportunities to Improve A Guide to the CAHPS QI Guidebook For each opportunity: Section 3. Implementing the CAHPS Improvement Cycle Plan Strategy - Create team (if needed) - Establish/confirm goals - Investigate potential interventions (see Section 4) Section 4.Ideas for Improving Experiences with Care • Develop and Test Strategy • - Select measures to monitor progress • Develop changes using selected intervention • Conduct small tests of change • Adapt changes to organizational context • - Identify and deal with barriers Reassess & Respond - Use CAHPS data to assess what worked, what didn’t - Spread successful innovations Getting needed care Getting care quickly Doctors communicate well Customer service Claims Processing Home health & preventive services Monitor Strategy - Implement changes and hold the gains - Evaluate progress against criteria

8. CAHPS and Quality Improvement • CAHPS III: • Refining QI model for implementing patient and family-centered care • Creation of a meta-model to guide practice redesign and implementation of patient and family-centered care; • Updating of CAHPS Improvement Guide to link with new Health Plan and Clinician-Group CAHPS surveys • Conversion to a web-based document to improve access and linkages to CAHPS reports.

9. Factors That May Contribute to Measurable and Sustained Improvement • Leadership is committed and engaged • Strategic goals are aimed at organizational transformation • Focusing on involving patients and families in redesign and improvement activities. • Focus on employee, clinician, and patient satisfaction. • Internal communication and action are aligned with strategic goals • Motivation through external rewards and incentives

10. Strategies for Clinician-Group CAHPS QI • Link patient experience of care data to internal incentive programs • Link patient experience of care data to external P4P programs • data to P4P and other incentives • Collect and report physician-level data

11. Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger.Franklin P. Jones

12. Strategies for Clinician-Group CAHPS QI • Perform analyses that address “50 ways to deny the data” • Staff surveys • Educational efforts at multiple levels of the organization • Link to other performance data • Panel size • Practice design • HEDIS data