Overview of CAHPS and the National CAHPS Database

1. Overview of CAHPS� and the National CAHPS� Database Assessing Patients� Experiences with Care: Using CAHPS� as a Standardized Quality Metric Dale Shaller, Shaller Consulting Managing Director, CAHPS Database Yale CAHPS III Team AHRQ Annual Conference September 15, 2009

2. 2 Overview of CAHPS CAHPS = Consumer Assessment of Healthcare Providers and Systems Most widely used survey tools for assessing the patient�s experience with care Endorsed by National Quality Forum Initiated and funded by AHRQ since 1995 Consortium members include: AHRQ, CMS, RAND, Yale/Harvard, and Westat

3. 3 Expanding Suite of CAHPS Surveys Hospitals Dialysis Facilities Nursing Homes Health Plans Group Practices and Individual Clinicians Behavioral Health Organizations (ECHO) Rural Tribe Health Services Home Health

4. 4 Core CAHPS Design Principles Focus on topics for which consumers are the best or only source of information Include patient reports and ratings of experiences � not �satisfaction� Reports: Never/Sometimes/Usually/Always Ratings: 0-10 rating scale Base question items and survey protocols on rigorous scientific development and testing, as well as extensive stakeholder input All surveys and services are in the public domain

5. 5 The CAHPS Database National repository of data from the CAHPS family of surveys Two major applications: Benchmarking to evaluate health system performance and support quality improvement Research on consumer assessments of quality Funded by AHRQ and administered by Westat through the CAHPS User Network

6. 6 National Advisory Group AHRQ CAHPS Grantees RAND Yale/Harvard CMS Medicare CMS Medicaid Department of Defense Consumer groups Employer groups State Medicaid Health plans Hospital systems Medical boards Statewide information organizations

7. 7 CAHPS Database Components CAHPS Health Plan Survey Database 3.6 million records collected 12 Annual Chartbooks (1998 � present) CAHPS Hospital Survey Database .8 million records collected 3 Annual Chartbooks (2006 � present) CAHPS Clinician & Group Survey Database

8. 8 CAHPS Database Products Online Reporting System Annual Chartbooks Customized Sponsor Reports Research Files Support to AHRQ�s National Healthcare Quality and Disparities Reports Special Analyses and Reports

9. 9 Benefits of Participation Free service open to all survey users on a voluntary basis Access to comparative results by survey version through Online Reporting System Support to participants provided through Data submission specifications Online data submission system Custom analysis and reports User network Email and phone technical support

10. 10 Online Reporting System Will support all CAHPS surveys maintained by CAHPS Database CAHPS Health Plan Survey CAHPS Hospital Survey CAHPS C&G Survey Public portal available to everyone Ability to view summary-level data only Password-protected portal will be accessible only to participants who contribute data Ability to view your own results compared to selected benchmarks

11. 11 This screenshot of the CAHPS Database Online Reporting System shows the selection of data for Health Plans (on the left) which takes you to an overview page for the Health Plan Data. Here there�s a description of the available data sets and a couple of windows to select the Year and specific Survey of interest. As shown on this page, I have selected 2008 data for the Adult Medicaid 4.0 plan survey. Other options would be Commercial or Medicare data, for either 2007 or 2008. Our plan is to always have loaded the current year and the prior year of data for comparison. Archives of earlier years will be available through our research files or the historical Chartbooks posted on the CAHPS web site.This screenshot of the CAHPS Database Online Reporting System shows the selection of data for Health Plans (on the left) which takes you to an overview page for the Health Plan Data. Here there�s a description of the available data sets and a couple of windows to select the Year and specific Survey of interest. As shown on this page, I have selected 2008 data for the Adult Medicaid 4.0 plan survey. Other options would be Commercial or Medicare data, for either 2007 or 2008. Our plan is to always have loaded the current year and the prior year of data for comparison. Archives of earlier years will be available through our research files or the historical Chartbooks posted on the CAHPS web site.

12. 12 So with my selection of 2008 Adult Medicaid data, I can now begin to look at various data views. The first shown here is my selection of a two-way frequency for one of the 2 questions that compose the Getting Needed Care Composite: Q27: (got necessary care, tests, or treatment through the health plan). I�ve checked the Question 27, and then I select my choice to view a 2-way frequency� So with my selection of 2008 Adult Medicaid data, I can now begin to look at various data views. The first shown here is my selection of a two-way frequency for one of the 2 questions that compose the Getting Needed Care Composite: Q27: (got necessary care, tests, or treatment through the health plan). I�ve checked the Question 27, and then I select my choice to view a 2-way frequency�

13. 13 Which is shown here comparing results for Q27 by self-reported health status (Q36). Other possible cuts include other respondent characteristics, or location, or plan type (as examples). As you can see, the frequency table shows the distribution of results with the number of respondents in each category.Which is shown here comparing results for Q27 by self-reported health status (Q36). Other possible cuts include other respondent characteristics, or location, or plan type (as examples). As you can see, the frequency table shows the distribution of results with the number of respondents in each category.

14. 14 Everything I�ve shown you thus far � and more -- related to the summary level data � including the ability to look at frequencies, bar charts, trend charts and to build your own reports based on the views you select � is available to anyone who visits the site. However, there is a very important second dimension to the online system that will be available only to those sponsors who contribute data. This is a password-protected area of the system where sponsors can view their own results compared to selected benchmarks. This shot illustrates that I have logged in as �Janice Ricketts�, who happens to be the CAHPS Database Manager at Westat and the person who has led the development of the online system. Now that I�m logged in through my password, I can now view everything on the �public� site as well as how my own data compare to selected benchmarks�Everything I�ve shown you thus far � and more -- related to the summary level data � including the ability to look at frequencies, bar charts, trend charts and to build your own reports based on the views you select � is available to anyone who visits the site. However, there is a very important second dimension to the online system that will be available only to those sponsors who contribute data. This is a password-protected area of the system where sponsors can view their own results compared to selected benchmarks. This shot illustrates that I have logged in as �Janice Ricketts�, who happens to be the CAHPS Database Manager at Westat and the person who has led the development of the online system. Now that I�m logged in through my password, I can now view everything on the �public� site as well as how my own data compare to selected benchmarks�

15. 15 For example, this is my own �sponsor� view of the Getting Needed Care Composite we looked at before. But this time I see not only the national, regional, and product type distributions, but also how the results of each of the plans in my own group (the Westat Group) compare. This list of individual plans is actually a bit longer than you see, if we could scroll down all the way, but what you can see is a list of Plans A through F for 2008 and their results for this composite. The chart also shows whether the mean score for each plan is above or below the national distribution for all health plans. (Note that results are case mix adjusted for age, education, and self-reported health status). For example, this is my own �sponsor� view of the Getting Needed Care Composite we looked at before. But this time I see not only the national, regional, and product type distributions, but also how the results of each of the plans in my own group (the Westat Group) compare. This list of individual plans is actually a bit longer than you see, if we could scroll down all the way, but what you can see is a list of Plans A through F for 2008 and their results for this composite. The chart also shows whether the mean score for each plan is above or below the national distribution for all health plans. (Note that results are case mix adjusted for age, education, and self-reported health status).

16. 16 Strategic Priorities Clinician & Group Survey Strong demand for benchmarks No other national suppliers Opportunity for leadership Health Plan Survey Partnership with NCQA and CMS Continued leadership in Medicaid sector Hospital Survey Collaboration with CMS

17. 17 CAHPS C&G Database Currently developing in response to user demand Working with key organizations to provide guidance on implementation Survey vendors Health plans and medical groups Aligning Forces for Quality and CVE markets National medical boards Aim is to support all C&G versions and users through standardized data submission specifications

18. 18 Clinician & Group Survey Core Measures

19. 19 Several C&G Survey Versions to Meet User Needs Last 12 months Adult primary care Child primary care Adult specialty care Visit-based Adult primary care

20. 20 Customizing Clinician & Group Survey with Supplemental Items Adult Primary Care 17 topics covered by supplemental items Includes health promotion and education, shared decision making, communication items for QI, most recent visit. Child Primary Care 7 topics covered by supplemental items Includes doctor communication with child, health improvement, shared decision making. Adult Specialty Care 6 topics covered by supplemental items Includes coordination of care, shared decision making, surgery or procedures performed by this doctor.

21. 21 Clinician & Group Survey: Under Construction Current surveys focus on primary and specialty care physicians CAHPS Consortium is developing a version to measure experience with a broader range of primary care providers (physicians, nurse practitioners, physician assistants) Potential for a �provider neutral� survey tool to assess any type of primary care provider Available as a beta survey instrument by the end of 2009

22. 22 Further Information To contribute data and obtain access to new online system, contact us: E-mail: ncbd1@ahrq.gov Toll-free number: 888-808-7108 For more information: https://www.cahps.ahrq.gov/default.asp