Assessing Patient-Centered Medical Homes from the Patient Perspective:

Developing the CAHPS® Clinician & Group PCMH Survey

Patricia Gallagher, PhD

Center for Survey ResearchUniversity of Massachusetts Boston

Yale CAHPS Team

Current CAHPS Consortium

AHRQGrantees

RANDYale

CAHPS User

NetworkWestat

Other Government and Private

Stakeholders

CMSNCQA

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The CAHPS Family of Surveys

• Family of surveys: comprehensive and evolving

• Patients evaluate their experiences with ambulatory and facility health care

• All surveys are in the public domain

CAHPS surveys ask about experiences with … AMBULATORY CARE

Clinicians and Medical Groups

Health plans Behavioral health

services Dental plans

FACILITIES Hospitals Nursing homes Dialysis facilities

Collaboration with NCQA

• Increasing attention to patient engagement was a key driver in NCQA’s update of its PCMH recognition program.

• NCQA conducted public comment to identify priorities for a PCMH survey

• Then worked with the CAHPS team to develop and test items

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CAHPS Design Principles

Emphasis on patients– What patients value with respect to the setting of care– Aspects of care for which patients are the best or only

source of information– Extensive testing with patients and families

Reports and ratings about experiences Standardization

– Questionnaires, data collection protocols, analysis, reporting Multiple versions for diverse populations

– Adult; Child; English & Spanish versions

All CAHPS surveys and products are in the public domain

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CAHPS Clinician & Group Survey: Patient-Centered Medical Home Version

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CAHPS Clinician & Group Core

Questionnaire*

CAHPS PCMH Item Set

CAHPS C&GPCMH Survey

* NQF endorsed

Overview of CAHPS C&G PCMH Surveys

• Expanded CAHPS C&G PCMH Surveys are appropriate for all primary care practices (PCMH and non-PCMH)

• Versions for Adult and Pediatric Populations

• Appropriate for general population

• 12-month “look-back” period

• Referent is “provider” or “provider’s office”

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NCQA’s PCMH 2011Recognition Program

• More emphasis on patient-centered care

• Use of patient surveys

• Additional credit for using the CAHPS C&G PCMH Survey

• NCQA also plans a separate distinction in Patient Experiences Reporting for PCMH practices that report the results of patient experiences surveys

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Overview of Development Process

• Technical Expert Panels (CAHPS and NCQA)• Literature review• Focus group feedback• Cognitive testing (English and Spanish)• Draft survey for Field Test• NCQA Field Test (English)• Psychometric analysis & Instrument refinement• NCQA Public Comment Period• Instrument Refinement• Public Release of C&G Survey with PCMH questions

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CAHPS C&G PCMH Survey Domains

Clinician & Group

- Access to Care

- Communication

- Office Staff

PCMH

- Comprehensiveness

- Self Management

Support

- Shared Decision Making

- Coordination of Care

- Information about Care

and Appointments10

Example of Item Development Issues #1

• PCMH Shared Decision Making Items– Screen for eligible respondents– Provider talked about reasons to take a medicine– Provider talked about reasons not to take a medicine– Provider asked what you thought was best for you

regarding medicine

• Notes:– Only in Adult questionnaire. Taking prescription meds

more rare in Pediatric population; SDM items included as pediatric supplemental set

– Tested Shared Decision Making related to surgery but incidence was too low

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Example of Item Development Issues#2

• PCMH Self Management Support Items

– Work with you to set specific goals for your health

– Ask you if there are things that make it hard for you to take care of your health

• Notes– PCMH Items are designed for a general population– Supplemental Items in development for population with

chronic conditions

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CAHPS C&G PCMH Survey Reporting:C&G Core + PCMH Measures (Slide 1)

CAHPS C&G Core: Composite Measures- Getting Timely Appointments, Care & Information (5 items)

- How Well Providers Communicate With Patients (6 items)

- Helpful, Courteous Office Staff (2 items)

Child Survey Only:

- Provider’s attention to your child’s growth & development (6)- Provider’s advice on keeping your child safe & healthy (5)

Provider Rating {PLUS …}

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CAHPS C&G PCMH Survey Reporting:C&G Core + PCMH Measures (Slide 2)PCMH Composite Measures

– Providers pay attention to your mental or emotional health (Adult only; 3 items)

– Providers support you in taking care of your own health (2 items)

– Providers discuss medication decisions (Adult only; 3 items)

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Public Release

• The expanded Clinician & Group 12-Month Survey with PCMH Items will soon be available for download on the new CAHPS website: http://www.cahps.ahrq.gov

• Measuring Patients’ Experiences with Medical Homes Using the CAHPS Patient-Centered Medical Home (PCMH) Item Set: o A free webcast sponsored by the

CAHPS User Networko Thurs, November 3, 2011, 2-3:30 ET

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CAHPS User Network Resources

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Users of CAHPS survey products and results have access to free resources: • CAHPS Clinician & Group Surveys and Instructions

• CAHPS Database

• Current information about CAHPS products

• Educational conferences and webcasts

• One-on-one technical assistance

CAHPS User Network

• Visit the CAHPS Website:http://www.cahps.ahrq.gov

• Call the Help Line1-800-492-9261

• Write the Help Line:cahps1@ahrq.gov

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• Thank you!

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Reference Slides

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RecommendedModes of Data Collection

• Mail Questionnaires only

• Telephone Interviews only

• Mixed Mode Administration– Mail + Telephone– Email + Mail/Telephone

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Overview of Adult Instrument

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Domain

C&G Core Item

Count

PCMH Item

Count

C&G Core + PCMH Item

Count

Access to Care 9 3 12Communication 7 1 8Comprehensiveness 0 3 3Office Staff 2 0 2Self Management Support 0 2 2Shared Decision Making 0 4 4Coordination of Care 2 4 6Information about Care & Appointments 0 3 3Overall Rating 1 0 1Eligibility 4 0 4Demographics 9 0 9Total Item Count 34 21 54

Overview of Pediatric Instrument

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Domain

C&G Core Item

Count

PCMH Item

Count

C&G Core + PCMH Item

Count

Access to Care 9 3 12Communication 14 0 14Comprehensiveness 11 0 11Office Staff 2 0 2Self Management Support 0 2 2Coordination of Care 2 4 6Information about Care & Appointments 0 3 3Overall Rating 1 0 1Eligibility 4 0 4Demographics 12 0 12Total Item Count 55 12 67

Overview of Survey Instruments

Access to Care• C&G Core

– Got appointment for urgent care as soon as needed– Got appointment for check-up or routine care as soon as

needed– Got answer to medical question the same day you phoned

provider's office– Got answer to medical question as soon as you needed when

phoned provider's office after hours– Saw provider within 15 minutes of appointment time

• PCMH Supplemental Items– Got needed care on evenings, weekends, or holidays– Days you had to wait for an appointment for urgent care

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Overview of Survey Instruments

Communication• C&G Core

– Provider explained things in a way that was easy to understand– Provider listened carefully– Provider gave easy to understand instructions about taking care

of health problems or concerns– Provider seemed to know important information about your

medical history– Provider respected what you had to say– Provider spent enough time with you

• PCMH Supplemental Items– Provider knew you as a person (Adult only)

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Overview of Survey Instruments

CommunicationPediatric only items

• C&G Core– Provider explained things in a way that was easy for child to

understand– Provider listened carefully to child– Provider gave you enough information about what was discussed

with child when you were not there– Provider gave you enough information about needed follow-up

for child's care

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Overview of Survey Instruments

ComprehensivenessGrowth and Development - Pediatric only items

• C&G Core– Talked about child's learning ability– Talked about behaviors that are normal for child at this age– Talked about how your child's body is growing– Talked about child's moods and emotions– Talked about how child gets along with others

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Overview of Survey Instruments

ComprehensivenessKeeping Child Safe and Healthy - Pediatric only items

• C&G Core– Talked about things to do to keep child from getting injured– Given information about keeping child from getting injured– Talked about how much time child spends in front of a computer

and TV– Talked about food your child eats– Talked about exercise your child gets– Talked about if there were problems in household that might

affect child

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Overview of Survey Instruments

ComprehensivenessBehavioral - Adult only items

• PCMH Items– Talked about personal or family problem/alcohol or drug use– Talked about worry and stress in your life– Talked about feeling sad or depressed

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Overview of Survey Instruments

Office Staff

• C&G Core– Clerks and receptionists at this office were as helpful as you

though they should be– Clerks and receptionists at this office treated you with courtesy

and respect

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Overview of Survey Instruments

Self Management Support

• PCMH Items

– Work with you to set specific goals for your health– Ask you if there are things that make it hard for you to take care

of your health

• Notes– PCMH Items are designed for a general population– Supplemental Items in development for population with chronic

conditions

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Overview of Survey Instruments

Shared Decision MakingAdult only items

• PCMH Items– Provider talked about reasons to take a medicine– Provider talked about reasons not to take a medicine– Provider asked what you thought was best for you regarding

medicine

• Notes– Taking prescription meds more rare in Pediatric population; items

included as pediatric supplemental– Tested Shared Decision Making related to surgery but incidence

was too low

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Overview of Survey Instruments

Coordination of Care

• C&G Core

– Provider's office followed up to give you results of blood test, x-ray, or other test

• PCMH Items

– Provider seemed informed and up-to-date about care you got from specialists

– Talked with you about your prescriptions

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Overview of Survey Instruments

Information about Care & Appointments

• PCMH Items

– Got information about what to do if you needed care on evenings, weekends, or holidays

– Received reminders between visits

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