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Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items.

ABSTRACT: Physical functioning is an important health domain for adults.Evaluate physical functioning items in Medicare beneficiaries.Survey data from the 2010 Consumer Assessment of Healthcare Providers and Systems Medicare survey.The 366,701 respondents were 58% female; 38% were 75 or older; 57% had high school education or less.Walking, getting in or out of chairs, bathing, dressing, toileting, and eating assessed with 3 response choices: unable to do, have difficulty, do not have difficulty.Pearson correlations among the 6 items ranged from 0.515 to 0.835 (coefficient ?=0.92). A single factor categorical factor analytic model fit the data well (comparative fit index=0.998; root mean square error of approximation=0.083). The item with the highest percentage of respondents reporting no difficulty was eating, followed by toileting, dressing, bathing, getting in and out of a chair, and walking. Threshold parameters from an item response theory-graded response model ranged from -1.983 (between unable to do and have difficulty eating) to -0.551 (between have difficulty and no difficulty walking). Item discrimination parameters ranged from 4.632 (walking) to 8.228 (dressing). IRT-scored physical functioning scores correlated with self-rated general health (r=0.389, n=344,843, P<0.0001) mental health (r=0.296, n=351,254, P<0.0001) and number of chronic conditions (r=-0.229, n=284,507, P<0.0001).The physical functioning items target relatively easy activities, providing information for a minority of people in the sample with the lowest levels of physical functioning. Items representing higher levels of physical functioning are needed for the majority of the Medicare beneficiaries.

SUBMITTER: Hays RD

PROVIDER: S-EPMC4713233 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items.

Hays Ron D RD Mallett Joshua S JS Gaillot Sarah S Elliott Marc N MN

Medical care 20160201 2

<h4>Background</h4>Physical functioning is an important health domain for adults.<h4>Objective</h4>Evaluate physical functioning items in Medicare beneficiaries.<h4>Research design</h4>Survey data from the 2010 Consumer Assessment of Healthcare Providers and Systems Medicare survey.<h4>Subjects</h4>The 366,701 respondents were 58% female; 38% were 75 or older; 57% had high school education or less.<h4>Measures</h4>Walking, getting in or out of chairs, bathing, dressing, toileting, and eating ass ...[more]

PMID: 26683780

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Project description:Rationale & Objective:The In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey, introduced into the End-Stage Renal Disease Quality Incentive Program, is the only patient-reported outcome currently used for value-based reimbursement in dialysis. Current response rates are ?30% and differences in long-term clinical outcomes between survey responders and nonresponders are unknown. Study Design:Retrospective cohort study. Setting & Participants:Patients from all Dialysis Clinic Incorporated facilities from across the United States who met survey eligibility (aged ?18 years and had been treated at their facility for at least 3 months). Exposures:Patient-level demographic, clinical, and treatment-related characteristics. Outcomes:Mortality, all-cause hospitalization, and kidney transplantation. Analytical Approach:Time-to-event analyses using competing-risks models. Sensitivity analyses performed after multiple imputation for missing covariate data. Results:Among 10,395 eligible patients, 3,794 (36%) responded to the survey. During a median follow-up of 33 months, 4,588 patients died, 7,638 patients were hospitalized at least once, and 789 patients received a transplant. In multivariable models, survey response was associated with lower mortality (subdistribution hazard ratio [sHR], 0.80; 95% CI, 0.75-0.86) and hospitalization (sHR, 0.94; 95% CI, 0.89-0.99) and higher likelihood for a kidney transplant (sHR, 1.27; 95% CI, 1.10-1.46). Results were consistent across sensitivity analyses after multiple imputation for missing covariates. Limitations:Small amount of missing covariate data, baseline covariate data assigned at the first month of the 3-month survey administration period, reasons for nonresponse unknown. Conclusions:Response to the ICH CAHPS survey is associated with lower risk for mortality and hospitalization and higher likelihood for kidney transplantation. These findings suggest that survey responders are healthier than nonresponders, emphasizing the need for caution when interpreting facility-level survey results to inform quality improvement and public policy efforts and the critical need to better capture patient-reported outcomes from more vulnerable patients.

Project description:Background and objectivesThe US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients.Design, setting, participants, & measurementsData were drawn from the Adelphi CKD Disease Specific Program (a retrospective, cross-sectional survey of nephrologists and patients). Selected United States-based nephrologists treating patients receiving hemodialysis completed patient record forms and provided information on their dialysis center. Patients (n=404) completed the CAHPS-ICH survey (comprising 58 questions) providing six scores for the assessment of patient experience of care. CAHPS-ICH item-scale convergence, discrimination, and reliability were evaluated for multi-item scales. Floor and ceiling effects were estimated for all six scores. Patient (demographics, dialysis history, vascular access method) and facility characteristics (size, ratio of patients-to-physicians, nurses, and technicians) associated with the CAHPS-ICH scores were also evaluated.ResultsItem-scale correlations and internal consistency reliability estimates provided support for the nephrologists' communication (range, 0.16-0.71; ?=0.81) and quality of care (range, 0.16-0.76; ?=0.90) composites. However, the patient information composite had low internal consistency reliability (?=0.55). Provider-to-patient ratios (range, 2.37 for facilities with >36 patients per physician to 2.8 for those with <8 patients per physician) and time spent in the waiting room (3.44 for >15 minutes of waiting time to 3.75 for 5 to <10 minutes) were characteristics most consistently related to patients' perceptions of dialysis care.ConclusionsCAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.

Dataset Information

Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items.

Publications

Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items.

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