Development and psychometric properties of the Japanese Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS).
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SUBMITTER: Aoki T
PROVIDER: S-EPMC8081233 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVE:To examine the effect of changing the sampling and reference periods for the CAHPS® Clinician & Group Survey from 12 to 6 months. DATA SOURCES/STUDY SETTING:Adult patients with a visit in the last 12 months to New England community health centers. STUDY DESIGN:We randomly assigned patients to receive a survey with either a 12- or 6-month recall period. DATA COLLECTION/EXTRACTION METHODS:Questionnaires were mailed to patients, with a second questionnaire mailed to nonrespondents, followed by six attempts to complete a telephone interview. PRINCIPAL FINDINGS:If the sampling criterion was a visit in the last 6 months, 9 percent of those with a visit in the last 12 months would not have been surveyed. A total of 1837 patients completed 6-month surveys (44.9 percent response rate); 588 completed 12-month surveys (46.0 percent response rate). Shortening the reference from 12 to 6 months reduced the proportion of respondents reporting a blood test, X-ray, or other tests. Adjusting for respondent characteristics, the most positive response was selected more often on the 6-month survey for 12 out of 13 questions, and three of these differences were statistically significant (P < 0.05). CONCLUSIONS:Surveys using a 6-month recall period may yield slightly higher scores than surveys with a 12-month recall period.
| S-EPMC6736918 | biostudies-literature
Project description:BackgroundThe In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey is the first patient reported outcome measure included in the U.S. Medicare End Stage Renal Disease Quality Incentive Program. Administered twice yearly, it assesses in-center dialysis experience and survey responses are tied to dialysis facility payments. Low response rates, currently approximately 35%, raise concern for possible underrepresentation of patient groups.MethodsCross-sectional analysis of survey administration in 2012 to all in-center hemodialysis patients in Dialysis Clinic, Inc. (DCI) facilities nationally over 18 years old who received hemodialysis at their facility for at least 3 months. Patient-level covariates included demographic, clinical, laboratory, and functional characteristics. Random effects multivariable logistic regression was used to assess survey non-response.ResultsAmong 11,055 eligible patients 6541 (59%) were non-responders. Of the remaining 4514 responders, 549 (14%) surveys were not usable due to presence of proxy help or incomplete responses. Non-responders were more likely to be men, non-white, younger, single, dual Medicare/Medicaid eligible, less educated, non-English speaking, and not active on the transplant list; non-responders had longer ESRD vintage, lower body mass index, lower serum albumin, worse functional status, and more hospitalizations, missed treatments, and shortened treatments. Similar associations were found using more parsimonious multivariable analyses and after imputing missing data.ConclusionsNon-responders to the ICH CAHPS significantly differed from responders, broadly spanning individuals with fewer socioeconomic advantages and greater illness burden, raising limitations in interpreting facility survey results. Future research should assess reasons for non-response to improve ICH CAHPS generalizability and utility.
| S-EPMC6194668 | biostudies-literature
Project description:BackgroundDifferences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance.MethodsWe evaluated the three-factor structure and the equivalence of responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinical and Group (CG-CAHPS) Adult Visit Survey 1.0 and compared care experiences of Asians and Whites. Thirteen questions were used to elicit reports about specific aspects of care and two questions assessed overall care perceptions. This analysis of the CAHPS database included 769 providers and 266,327 respondents. Most surveys (98%) were administered by mail and the rest (2%) by phone. Only 0.5% of the surveys were administered in Spanish. The sample was 64% female, 89% White and 2% Asian, 39% 65 years or older, and 32% were high school graduates or less.ResultsA three-factor model was supported by categorical confirmatory factor analysis using weighted least squares with mean and variance adjustment: confirmatory fit index (CFI) = 0.99 and root mean squared error of approximation (RMSEA) = 0.03). A multi-group configural invariance model also fit the data well: (CFI = 0.993, RMSEA = 0.031). Regression models indicated that Asians reported worse access, lower scores on office staff courtesy and helpfulness and rating their doctors and were less likely to recommend their doctors to family/friends than did Whites.ConclusionsUse of the CG-CAHPS Adult Visit Survey 1.0 to assess perceptions of care by Asians and Whites is supported. Quality improvement efforts are needed to address worse experiences of care among Asians in the United States.
| S-EPMC7990982 | biostudies-literature
Project description:BackgroundPhysical functioning is an important health domain for adults.ObjectiveEvaluate physical functioning items in Medicare beneficiaries.Research designSurvey data from the 2010 Consumer Assessment of Healthcare Providers and Systems Medicare survey.SubjectsThe 366,701 respondents were 58% female; 38% were 75 or older; 57% had high school education or less.MeasuresWalking, 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.ResultsPearson correlations among the 6 items ranged from 0.515 to 0.835 (coefficient α=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).ConclusionsThe 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.
| S-EPMC4713233 | biostudies-literature
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.
| S-EPMC7380364 | biostudies-literature
Project description:BackgroundPatient experience in hemodialysis (HD) is measured twice yearly in all in-center HD patients in the United States using the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. Survey scores are publically available and incorporated into the dialysis payment system. Despite its importance, little is known about factors associated with better experience scores. We studied the association between patient-level characteristics and experience scores in a large real-world cohort of HD patients.MethodsThis is a cross-sectional analysis of ICH CAHPS administration in 2012. All in-center HD patients in Dialysis Clinic, Incorporated facilities nationally over 18 years old and receiving HD at their facility for at least 3 months were eligible. Predictors include patient demographic, clinical, and treatment-related characteristics. Outcomes include high global rating scores across three domains (Nephrologist, Dialysis Staff, Dialysis Center) and high composite scores across three domains (Nephrologists' Communication and Caring, Quality of Dialysis Center Care and Operations, and Providing Information to Patients).ResultsAmong 3369 respondents, older age and telephone (vs. mail) administration of the survey were associated with higher global ratings, while shortened HD treatments were associated with lower global ratings. Lower education and telephone administration were associated with higher composite scores, while older age, and shortened HD treatments were associated with lower composite scores.ConclusionsSeveral patient characteristics and mode of survey administration are associated with higher experience scores. Future research should assess HD facility characteristics associated with higher scores and interventions that might improve experience accounting for these associations.
| S-EPMC6264620 | biostudies-literature
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.
| S-EPMC4046733 | biostudies-literature
Project description:ObjectiveTo evaluate psychometric properties of a widely used patient experience survey.Data sourcesEnglish-language responses to the Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS®) survey (n = 12,244) from a 2008 quality improvement initiative involving eight southern California medical groups.MethodsWe used an iterative hybrid ordinal logistic regression/item response theory differential item functioning (DIF) algorithm to identify items with DIF related to patient sociodemographic characteristics, duration of the physician-patient relationship, number of physician visits, and self-rated physical and mental health. We accounted for all sources of DIF and determined its cumulative impact.Principal findingsThe upper end of the CG-CAHPS® performance range is measured with low precision. With sensitive settings, some items were found to have DIF. However, overall DIF impact was negligible, as 0.14 percent of participants had salient DIF impact. Latinos who spoke predominantly English at home had the highest prevalence of salient DIF impact at 0.26 percent.ConclusionsThe CG-CAHPS® functions similarly across commercially insured respondents from diverse backgrounds. Consequently, previously documented racial and ethnic group differences likely reflect true differences rather than measurement bias. The impact of low precision at the upper end of the scale should be clarified.
| S-EPMC3393020 | biostudies-literature
Project description:ObjectiveTo assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences.Data sources/study settingMultisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State.Data collection/extraction methodsMail and handout distribution modes were alternated weekly at each site for 6 weeks.Principal findingsHandout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode-physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode.ConclusionsIn-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences.
| S-EPMC2965508 | biostudies-literature
Project description:Although prior work has investigated the interplay between demographic and intrasurvey correlations of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, these prior studies have not included geospatial analyses, or analyses that take into account location effects. Here, we report the results of a geospatial analysis (not equivalent to simple geographical analysis) of patient experience scores pertaining to pain. HCAHPS data collected in 2011 were examined to test the hypothesis that HCAHPS patient experience with pain management (PEPM) scores were geospatially distributed throughout the United States using Moran's Index, which measures the association between PEPM scores and hospital location. After limiting the dataset to hospitals in the continental United States with nonzero HCAHPS response rates, 3645 hospitals were included in the analyses. "Always" responses were geospatially clustered amongst the analyzed hospitals. Clustering was significant in all distances tested from 10 to 5000km (P<0.0001). We identified 6 demarcated groups of hospitals. Taken together, these results strongly suggest a regional geographic effect on PEPM scores. These results may carry policy implications for U.S. hospitals with regard to acute pain outcomes. Further analyses will be necessary to evaluate policy explanations and implications of the regional geographic differences in PEPM results.
| S-EPMC4086258 | biostudies-literature