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Quigley DD, Elliott MN, Qureshi N, Predmore Z, Hays RD. How the CAHPS Clinician and Group Patient Experience Survey Data Have Been Used in Research: A Systematic Review. J Patient Cent Res Rev 2024; 11:88-96. [PMID: 39044849 PMCID: PMC11262838 DOI: 10.17294/2330-0698.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Purpose Patient experience is a key aspect of care quality. The Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) survey measures experiences with ambulatory care providers to inform public reporting, pay-for-performance initiatives, interventions, patient choice of physicians/practices, and quality improvement. Since the survey's 2007 release, no systematic review of its use in research has been published. Methods We reviewed English-language, peer-reviewed articles published since 2008 using CG-CAHPS survey data in the U.S. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Checklist for Analytical Cross-Sectional Studies. Results We examined 126 articles and included 52. Twenty-seven articles focused on general primary care, and the others focused on ambulatory specialty care. Of the 52 studies, 37 were cross-sectional, and the majority conducted patient-level regression analysis, controlling for patient characteristics. The most-used CAHPS measures were overall provider rating and the provider communication composite. CG-CAHPS data were primarily utilized to evaluate interventions (24 studies) and examine cross-sectional associations (21 studies) of site-level (eg, organizational climate), provider-level (physician empathy), and patient-level (medication adherence) factors with patient experience. Four studies reported disparities in patient experience. Conclusions The widespread use of CG-CAHPS data implies the survey's value in measuring and improving care quality. Unlike facility or plan surveys, the CG-CAHPS survey was designed to allow attribution to medical groups and clinicians, which, as evidence shows, is its main strength. Policymakers, researchers, clinicians, and health care leaders can leverage CG-CAHPS data in quality improvement efforts and interventions supporting patient-centered care.
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Affiliation(s)
| | | | | | | | - Ron D. Hays
- RAND Corporation, Santa Monica, CA
- UCLA David Geffen School of Medicine & Department of Medicine, Los Angeles, CA
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Tymms K, O'Sullivan C, Smith T, Littlejohn G, Freeman T, Hoffman D, Segelov D, Griffiths H, Ciciriello S, Youssef P, Mathers D, Deakin CT. A novel electronic patient-reported outcome delivery system to implement health-related quality of life measures in routine clinical care: An analysis of 5 years of experience. Front Digit Health 2023; 4:1074931. [PMID: 36698650 PMCID: PMC9869675 DOI: 10.3389/fdgth.2022.1074931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To develop a simple and secure technological solution to incorporate electronic patient-reported outcomes (ePROs) into routine clinical care. Methods A novel ePRO questionnaire delivery system was developed by Software for Specialists (S4S) in partnership with OPAL Rheumatology Australia. Validated questionnaires were sent from the electronic medical record (EMR) (Audit4) of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), lupus or giant cell arteritis (GCA) and delivered to the patient's email address or completed in the clinic waiting room using a smart device (in-practice). Completed questionnaires were encrypted and returned to the patient's Audit4. Deidentified clinical data was extracted and aggregated across all sites. Data collected between April 2016-Dec 2020 were analysed descriptively. Results Between April 2016 to Dec 2020, 221,352 Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), Patient Health Questionnaire-2 (PHQ-2) and/or HealthCare Resource Utilization (HCRU) questionnaires were sent from 39 of 42 contributing clinics (93%). 85% of questionnaires were delivered via email and 15% in-practice. Overall, 85% of patients completed at least one questionnaire, and of all questionnaires sent, 73% were completed. Females were more likely to engage with the questionnaires than males (87% vs. 81%), and older patients were slightly more likely to complete all questionnaires delivered. Conclusions The novel Audit4 ePRO delivery system is an effective tool for incorporating PROs into routine clinical care. The data generated provides a unique opportunity to understand the full burden of disease for patients in the real-world setting and the impact of interventions.
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Affiliation(s)
| | | | | | - Geoffrey Littlejohn
- OPAL Rheumatology, Sydney, NSW, Australia,Monash University, Clayton, VIC, Australia
| | - Tim Freeman
- Software4Specialists Pty Ltd, Sydney, NSW, Australia
| | - David Hoffman
- Software4Specialists Pty Ltd, Sydney, NSW, Australia
| | - Dana Segelov
- Software4Specialists Pty Ltd, Sydney, NSW, Australia
| | - Hedley Griffiths
- OPAL Rheumatology, Sydney, NSW, Australia,Barwon Rheumatology Service, Geelong, VIC, Australia
| | - Sabina Ciciriello
- OPAL Rheumatology, Sydney, NSW, Australia,Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Peter Youssef
- OPAL Rheumatology, Sydney, NSW, Australia,University of Sydney, Sydney, NSW, Australia,Royal Prince Alfred, Camperdown, NSW, Australia
| | - David Mathers
- OPAL Rheumatology, Sydney, NSW, Australia,Georgetown Arthritis, Newcastle, NSW, Australia
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Mou D, Mjaset C, Sokas CM, Virji A, Bokhour B, Heng M, Sisodia RC, Pusic AL, Rosenthal MB. Impetus of US hospital leaders to invest in patient-reported outcome measures (PROMs): a qualitative study. BMJ Open 2022; 12:e061761. [PMID: 35793919 PMCID: PMC9260769 DOI: 10.1136/bmjopen-2022-061761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA. DESIGN Exploratory qualitative study. SETTING Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states. METHODS Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis. RESULTS Leaders strongly believe that collecting PROMs is the 'right thing to do' and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric. CONCLUSION These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.
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Affiliation(s)
- Danny Mou
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christer Mjaset
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Commonwealth Fund, New York, New York, USA
| | - Claire M Sokas
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Azan Virji
- Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Bokhour
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marilyn Heng
- Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel C Sisodia
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcome Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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Kwan YH, Fong W, Woon TH, Phang JK, Png K, Lau JQ, Leung YY, Tan CS, Østbye T, Thumboo J. Development of an Item Bank for a health-related quality of life Measure in Spondyloarthritis. J Rheumatol 2022; 49:1006-1011. [PMID: 35649556 DOI: 10.3899/jrheum.210980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQOL) is an important aspect in the management of chronic diseases such as spondyloarthritis (SpA). A promising approach to reduce respondent burden when measuring HRQOL is the use of shorter patient-reported outcome measures (PROMs) delivered using computer-adaptive tests (CATs). However, the lack of an item bank which covers the entire continuum of the HRQOL domain impedes the development of CAT to measure HRQOL among patients with SpA. We aim to develop an item bank for a HRQOL measure among patients with SpA based on the items from existing validated PROMs. METHODS This study is guided by the preferred reporting items for systematic review and metaanalysis (PRISMA) and Patient Reported Outcomes Measurement Information System (PROMIS) Cooperative Group guidelines. Relevant articles were retrieved from PubMed®, Embase®, and PsycINFO® (Ovid) databases. Items from existing PROMs were "binned" and "winnowed" according to the facets of HRQOL in the World Health Organisation (WHO) QOL framework. RESULTS We identified 147 relevant articles. 1039 items from 31 PROMs of which permission has been obtained for inclusion into the item bank underwent binning and winnowing. This resulted in 968 items covering 23 domains of HRQOL in the WHO framework, with the number of items within each domain ranging from 1 to 453. CONCLUSION We created an item bank to measure HRQOL among patients with SpA using items from validated PROMs. This set can provide the foundation for the development of CATs to measure HRQOL among patients with SpA.
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Affiliation(s)
- Yu Heng Kwan
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Warren Fong
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Ting Hui Woon
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Jie Kie Phang
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Kelly Png
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Jia Qi Lau
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Ying Ying Leung
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Chuen Seng Tan
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Truls Østbye
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Julian Thumboo
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
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