1
|
Pandit AA, Halpern MT, Gressler LE, Kamel M, Payakachat N, Li C. Association of race/ethnicity and patient care experiences with healthcare utilization and healthcare costs among prostate cancer survivors: A SEER- CAHPS study. J Geriatr Oncol 2024; 15:101748. [PMID: 38493533 PMCID: PMC11017784 DOI: 10.1016/j.jgo.2024.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION This study aimed to evaluate the association of race/ethnicity and patient care experiences (PCEs) with healthcare utilization and costs among US older adults with prostate cancer (PCa). MATERIALS AND METHODS The study used data from 2007 to 2015 Surveillance, Epidemiology, and End Results dataset linked to Medicare Consumer Assessment of Healthcare Providers and Systems survey and Medicare claims (SEER-CAHPS). We identified males aged ≥65 years who completed a CAHPS survey within 6-60 months post-PCa diagnosis. Covariate-adjusted associations of six CAHPS PCE composite measures with any emergency department visit and any inpatient stay (using logistic regressions), and with total part A and part B Medicare costs (using generalized linear models) were examined by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, and other). RESULTS Among 1834 PCa survivors, a 1-point higher score for getting care quickly was associated with higher odds (odds ratio 1.08; 95% confidence interval [CI]: 1.02-1.15; p = 0.009) of any inpatient stay in Hispanic patients. Higher total costs were associated with a 1-point higher score for getting needed care among Hispanic patients ($590.84; 95% CI: $262.15, $919.53; p < 0.001); a 1-point higher score for getting care quickly among Hispanic patients ($405.26; 95% CI: $215.83, $594.69; p < 0.001); and a 1-point higher score for customer service among patients belonging to other races ($361.69; 95% CI: $15.68, $707.69; p = 0.04). DISCUSSION We observed differential associations by race/ethnicity between PCEs and healthcare utilization and costs. Further research is needed to explore the causes of these associations.
Collapse
Affiliation(s)
- Ambrish A Pandit
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E342, Bethesda, MD 20892-9762, United States.
| | - Laura E Gressler
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Medical Sciences Building Room 2519, 231 Albert Sabin Way Suite 2501, 45267 Cincinnati, OH, United States; Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Chenghui Li
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| |
Collapse
|
2
|
Pandit AA, Halpern MT, Gressler LE, Kamel M, Payakachat N, Li C. Association of race/ethnicity and patient care experiences with receipt of definitive treatment among prostate cancer survivors: a SEER- CAHPS study. Cancer Causes Control 2024; 35:647-659. [PMID: 38001335 DOI: 10.1007/s10552-023-01834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE This study aimed to evaluate the association of race/ethnicity, patient care experiences (PCEs), and receipt of definitive treatment and treatment modality among older adults in the United States (US) with localized prostate cancer (PCa). METHODS Using Surveillance, Epidemiology and End Results dataset linked to Medicare Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) for 2007-2015, we identified men aged ≥ 65 years who completed a CAHPS survey within one year before and one year after PCa diagnosis. Associations of race/ethnicity (non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, non-Hispanic Asian (NHA), and other) and of interactions between race/ethnicity and PCEs (getting needed care, getting care quickly, doctor communication, and care coordination) with the receipt of definitive PCa treatment and treatment modality within 3 and 6 months of diagnosis were examined using logistic regressions. RESULTS Among 1,438 PCa survivors, no racial/ethnic disparities in the receipt of definitive treatment were identified. However, NHB patients were less likely to receive surgery (vs. radiation) within 3 and 6 months of PCa diagnosis than NHW patients (OR 0.397, p = 0.006 and OR 0.419, p = 0.005), respectively. Among NHA patients, a 1-point higher score for getting care quickly was associated with lower odds (OR 0.981, p = 0.043) of receiving definitive treatment within 3 months of PCa diagnosis, whereas among NHB patients, a 1-point higher score for doctor communication was associated with higher odds (OR 1.023, p = 0.039) of receiving definitive treatment within 6 months of PCa diagnosis. DISCUSSION We observed differential associations between PCEs and receipt of definitive treatment based on patient race/ethnicity. Further research is needed to explore these associations.
Collapse
Affiliation(s)
- Ambrish A Pandit
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, 72205, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892-9762, USA
| | - Laura E Gressler
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, 72205, USA
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Medical Sciences Building, 231 Albert Sabin Way Suite 2501, Cincinnati, OH, 45267, USA
- Department of Urology, Ain Shams University, Cairo, 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, 72205, USA
| | - Chenghui Li
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, 72205, USA.
| |
Collapse
|
3
|
Tolpadi A, Elliott MN, Becker K, Lehrman WG, Stark D, Parast L. Exploring Which Patients Use Their Closest Emergency Departments Using Geocoded Data. J Emerg Med 2023; 65:e290-e302. [PMID: 37689542 DOI: 10.1016/j.jemermed.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Each year, roughly 20% of U.S. adults visit an emergency department (ED), but little is known about patients' choice of ED. OBJECTIVES Examine the discretion patients have to choose among EDs, characteristics associated with ED choice, and relationship between ED choice and self-reported care experiences of ED patients. METHODS We surveyed adult patients discharged to the community (DTC) in January-March 2018 from 16 geographically dispersed hospital-based EDs, geocoded patient and hospital-based ED addresses within 100 miles of patient addresses, and calculated travel distances. We examined the likelihood of visiting the closest ED based on patient and ED characteristics. Linear regression models examined the association of choosing the closest ED with seven measures of patient experience of care (scaled 0-100), adjusting for patient characteristics. RESULTS 43.6% of 4647 responding patients visited the ED nearest their home (on average, 5.7 miles away). Patients who chose a farther ED had more urgent conditions, were more educated, and were less likely to be non-Hispanic White. They were significantly more likely to have visited an ED in a higher-rated, metropolitan, network hospital with major teaching status, a cardiac intensive care unit, and a certified trauma center. Patients who chose a farther ED were more likely to recommend that ED, with "medium-to-large" differences in scores (+4.3% more selected "definitely yes", p < 0.05). CONCLUSIONS Fewer than half of patients visited the closest ED. Patients who chose a farther ED tended to seek higher-rated hospitals and report more favorable experiences.
Collapse
Affiliation(s)
| | | | | | | | - Debra Stark
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Layla Parast
- Department of Statistics and Data Sciences, The University of Texas at Austin, Austin, Texas.
| |
Collapse
|
4
|
Quigley DD, Elliott MN, Slaughter ME, Talamantes E, Hays RD. Shadow Coaching Improves Patient Experience for English-Preferring Patients but not for Spanish-Preferring Patients. J Gen Intern Med 2023; 38:2494-2500. [PMID: 36797540 PMCID: PMC10465456 DOI: 10.1007/s11606-023-08045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shadow coaching, a type of one-on-one provider counseling by trained peers, is an effective strategy for improving provider behaviors and patient interactions, but its effects on improving patient experience for English- and Spanish-preferring patients is unknown. OBJECTIVE Assess effects of shadow coaching on patient experience for English- and for Spanish-preferring patients. DESIGN We analyzed 2012-2019 Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) data (n=46,089) from an urban Federally Qualified Health Center with 44 primary care practices and 320 providers. One-third (n=14,631) were Spanish-preferring patients. We fit mixed-effects regression models with random effects for provider (the level of treatment assignment) and fixed effects for time (a linear spline for time with a knot and "jump" at coaching date), patient characteristics, and site indicators, stratified by preferred language. PARTICIPANTS The 74 providers who had a 6-month average top-box score on the CAHPS overall provider rating below 90 (on a 100-point scale) were shadow coached. Similar percentages of English-preferring (45%) and Spanish-preferring patients (43%) were seen by coached providers. INTERVENTION Trained providers observed patient care by colleagues and provided suggestions for improvement. Verbal feedback was provided immediately after the observation and the participant received a written report summarizing the comments and recommendations from the coaching session. MAIN MEASURES CG-CAHPS Visit Survey 2.0 provider communication composite and overall provider rating (0-100 scoring). KEY RESULTS We found a statistically significant 2-point (small) jump in CAHPS provider communication and overall provider rating among English-preferring patients of coached providers. There was no evidence of a coaching effect on patient experience for Spanish-preferring patients. CONCLUSIONS Coaching improved care experiences for English-preferring patients but may not have improved patient experience for Spanish-preferring patients. Selection and training of providers to communicate effectively with Spanish-preferring patients is needed to extend the benefits of shadow coaching to Spanish-preferring patients.
Collapse
Affiliation(s)
| | - Marc N. Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | | | | | - Ron D. Hays
- UCLA David Geffen School of Medicine & Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736 USA
| |
Collapse
|
5
|
Gotthardt CJ, Haynes SC, Sharma S, Yellowlees PM, Luce MS, Marcin JP. Patient Satisfaction with Care Providers During the COVID-19 Pandemic: An Analysis of Consumer Assessment of Healthcare Providers and Systems Survey Scores for In-Person and Telehealth Encounters at an Academic Medical Center. Telemed J E Health 2023; 29:1114-1126. [PMID: 36595515 DOI: 10.1089/tmj.2022.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Previous research has demonstrated high patient satisfaction with telehealth encounters. The objective of this study was to compare patient satisfaction scores regarding their physician using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys between in-person and telehealth outpatient encounters during the pandemic at a large academic health center. Methods: We analyzed CAHPS patient satisfaction survey data within the UC Davis Health system between August 2020 and February 2022. The questions analyzed pertained to patients' satisfaction with their care provider; whether they felt included in discussions, would recommend their physician, received clear explanations, and that their concerns were heard. Using logistic regression models adjusting for confounders, we compared CAHPS care provider top box scores-a score of 4 or 5 on the 5-point scale-for 5 survey items. Results: Survey results from 76,687 (84.2%) in-person encounters and 14,404 (15.8%) telehealth encounters were evaluated. The odds of a telehealth patient giving a top box score for whether they would recommend their care provider to others were 0.97 those of an in-person patient (95% confidence interval [0.87-1.06]; p = 0.494). Similarly, there was no significant difference in odds of giving a top box score between telehealth and in-person patients for the other four questions analyzed. Discussion: Our findings indicate that patient experience and care provider rankings for in-person care and telehealth care are comparable across a variety of specialties and conditions at a large academic health center. Future studies should investigate patient satisfaction with in-person and telehealth encounters by diagnosis and specialty.
Collapse
Affiliation(s)
| | | | - Sristi Sharma
- University of California, Davis, Davis, California, USA
| | | | | | | |
Collapse
|
6
|
Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Differences in racial/ethnic disparities in patient care experiences between prostate cancer survivors and males without cancer: A SEER- CAHPS study. J Geriatr Oncol 2023; 14:101554. [PMID: 37320932 PMCID: PMC10335318 DOI: 10.1016/j.jgo.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/14/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Our purpose was to evaluate whether racial/ethnic disparities in patient care experiences (PCEs) differ between males with prostate cancer ("PCa group") and males without cancer ("non-cancer group"). MATERIALS AND METHODS This retrospective study used 2007-2015 National Cancer Institute's Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. PCa and non-cancer groups were propensity score matched 1:5 on demographic and clinical characteristics. Differences in racial/ethnic disparities (DRD) (non-Hispanic Black [NHB], Hispanic, non-Hispanic Asian [NHA], and Other Races compared to non-Hispanic White [NHW]) in PCEs (getting needed care, getting care quickly, doctor communication, customer service, and getting needed prescription drugs) were compared between matched PCa and non-cancer groups. Per prior literature, DRD in PCE scores were categorized as small (<3), medium (≥3 but <5) or large (≥5). RESULTS There were 7312 males in the PCa group and 36,559 matched males in the non-cancer group. Within each group, all racial/ethnic minority categories reported worse scores compared to NHW individuals (p < 0.05) for ≥3 PCE composite measures. Compared to PCa group, a larger NHA-NHW difference was observed in non-cancer group for getting needed care (-4.65 in PCa vs. -7.77 in non-cancer; DRD = 3.11, p = 0.029) and doctor communication (-2.46 in PCa vs. -4.85 in non-cancer; DRD = 2.38, p = 0.023). DISCUSSION In both PCa and non-cancer groups, racial/ethnic minorities reported worse experiences compared to NHW individuals for several PCE measures. However, the difference in getting needed care and doctor communication between NHA and NHW individuals were more pronounced in non-cancer group than PCa group.
Collapse
Affiliation(s)
- Ambrish A Pandit
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Laura E Gressler
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America; Department of Urology, Ain Shams University, Cairo 11566, Egypt.
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| |
Collapse
|
7
|
Quigley DD, Elliott MN, Slaughter ME, Talamantes E, Hays RD. Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis. J Gen Intern Med 2023; 38:221-227. [PMID: 36344646 PMCID: PMC9640810 DOI: 10.1007/s11606-022-07881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Shadow coaching improves provider-patient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time. AIM Examine whether a second coaching session (re-coaching) improves and sustains patient experience. SETTING Large, urban Federally Qualified Health Center PROGRAM: Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0-100-point scale) were eligible. EVALUATION We used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixed-effects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible "jump" at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after re-coaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC. DISCUSSION Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.
Collapse
Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Mary E Slaughter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA, USA
| |
Collapse
|
8
|
Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Racial/Ethnic Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER- CAHPS Study. Curr Oncol 2022; 29:8357-8373. [PMID: 36354719 PMCID: PMC9689524 DOI: 10.3390/curroncol29110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate racial/ethnic disparities in patient care experiences (PCEs) among prostate cancer (PCa) survivors. METHODS This retrospective study used 2007-2015 National Cancer Institute Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. First survey ≥ 6 months post-PCa diagnosis was analyzed. We performed multivariable linear regression, adjusting for demographic and clinical covariates, to evaluate the association of race/ethnicity (non-Hispanic Whites (NHWs), non-Hispanic Black (NHBs), Hispanic, non-Hispanic Asian (NHAs), and other races) with PCE composite measures: getting needed care, doctor communication, getting care quickly, getting needed prescription drugs (Rx), and customer service. RESULTS Among 7319 PCa survivors, compared to NHWs, Hispanics, NHBs and NHAs reported lower scores for getting care quickly (ß = -3.69; p = 0.002, ß = -2.44; p = 0.021, and ß = -6.44; p < 0.001, respectively); Hispanics scored worse on getting needed care (ß = -2.16; p = 0.042) and getting needed Rx (ß = -2.93; p = 0.009), and NHAs scored worse on customer service (ß = -7.60; p = 0.003), and getting needed Rx (ß = -3.08; p = 0.020). However, NHBs scored better than NHWs on doctor communication (ß = 1.95, p = 0.006). No statistically significant differences were found between other races and NHWs. CONCLUSIONS Comparing to NHWs, Hispanics and NHAs reported worse experiences on several PCE composite measures, while NHBs reported worse scores on one but better scores on another PCE composite measure. Further research is needed to understand the reasons behind these disparities and their influence on healthcare utilization and health outcomes among PCa survivors.
Collapse
Affiliation(s)
- Ambrish A. Pandit
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Laura E. Gressler
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mohamed Kamel
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Chenghui Li
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
- Correspondence: ; Tel.: +1-(501)-686-6298
| |
Collapse
|
9
|
Arevalo M, Pickering TA, Vernon SW, Fujimoto K, Peskin MF, Farias AJ. Do breast cancer survivors with a recent history of clinical depression report worse experiences with care? A retrospective cohort study using SEER- CAHPS data. Cancer Med 2022; 12:1949-1960. [PMID: 35929584 PMCID: PMC9883547 DOI: 10.1002/cam4.5031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity. METHODS Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, getting care quickly, getting prescription drugs, specialist and overall care). We also assessed interactions of depression by race/ethnicity. All models were adjusted for demographics and cancer prognostic and treatment factors. RESULTS Of the 2271 survivors, 7.6% were clinically depressed. After adjusting for covariates, survivors with clinical depression had lower odds of reporting excellent ratings of their ability to get needed care, care by their specialist, and overall care, compared to those without depression (AOR = 0.58, 95% CI: 0.40-0.84; AOR = 0.40, CI: 0.31-0.76; and AOR = 0.61, CI: 0.42-0.89, respectively). Among Hispanics, having depression was associated with higher odds of excellent ratings of one's ability to get needed care (AOR: 5.42, 95% CI: 1.02-28.81). No other statistically significant associations by race/ethnicity were found. CONCLUSIONS Breast cancer survivors with depression report poorer patient experiences with care. Further research is needed to understand complexities of ratings of experiences with care among survivors of diverse backgrounds. IMPLICATIONS Survivors with a recent history of clinical depression may benefit from additional supportive care services.
Collapse
Affiliation(s)
- Mariana Arevalo
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Trevor A. Pickering
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sally W. Vernon
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Melissa F. Peskin
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Albert J. Farias
- Department of Preventive MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Gehr Family Center for Health System ScienceKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Cancer Control Research ProgramUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| |
Collapse
|
10
|
Rudy ET, McNamara KC, Goldberg ZN, Parker A, Nash DB. A Call for Consistent Measurement Across the Social Determinants of Health Industry Landscape. Popul Health Manag 2022; 25:698-701. [PMID: 35880878 DOI: 10.1089/pop.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ellen T Rudy
- Department of Research and Impact, Papa, Inc., Miami, Florida, USA.,Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | | | - Zachary N Goldberg
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Parker
- Department of Research and Impact, Papa, Inc., Miami, Florida, USA
| | - David B Nash
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Fowler FJ, Brenner PS, Cosenza C, Cleary PD. How responding in Spanish affects CAHPS results. BMC Health Serv Res 2022; 22:884. [PMID: 35804382 PMCID: PMC9264710 DOI: 10.1186/s12913-022-08262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most widely used surveys for assessing patient health care experiences in the U.S. are the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies examining the associations of language and ethnicity with responses to CAHPS surveys have yielded inconsistent findings. More research is needed to assess the effect of responding to CAHPS surveys in Spanish. METHODS Subjects were patients who had received care at a study community health center in Connecticut within 6 or 12 months of being sent a CAHPS survey that asks about care experiences. The survey included four multi-item measures of care plus an overall rating of the provider. Sampled patients were mailed dual language (English and Spanish) cover letters and questionnaires. Those who did not respond after follow-up mailings were contacted by bilingual interviewers to complete the survey by telephone. We tested three hypotheses for any observed differences by ethnicity and language: 1. Spanish speakers are more likely than others to choose extreme response options. 2. The semantic meaning of the Spanish translation is not the same as the English version of the questions, resulting in Spanish speakers giving different answers because of meaning differences. 3. Spanish speakers have different expectations regarding their health care than those who answer in English. Analyses compared the answers on the survey measures for three groups: non-Hispanics answering in English, Hispanics answering in English, and Hispanics answering in Spanish. RESULTS The overall response rate was 45%. After adjusting for differences in demographic characteristics and self-rated health, those answering in Spanish gave significantly more positive reports than the other two groups on three of the five measures, and higher than the non-Hispanic respondents on a fourth. CONCLUSIONS Those answering in Spanish gave more positive reports of their medical experiences than Hispanics and non-Hispanics answering in English. Whether these results reflect different response tendencies, different standards for care, or better care experiences is a key issue in whether CAHPS responses in Spanish need adjustment to make them comparable to responses in English.
Collapse
Affiliation(s)
- Floyd J Fowler
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA
| | - Philip S Brenner
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA
- Department of Sociology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA
| | - Paul D Cleary
- Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| |
Collapse
|
12
|
Quigley D, Qureshi N, Rybowski L, Shaller D, Edgman-Levitan S, Cleary PD, Ginsberg C, Hays RD. Summary of the 2020 AHRQ research meeting on 'advancing methods of implementing and evaluating patient experience improvement using consumer assessment of healthcare providers and systems ( CAHPS®) surveys'. Expert Rev Pharmacoecon Outcomes Res 2022; 22:883-890. [PMID: 35510496 DOI: 10.1080/14737167.2022.2064848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Agency for Healthcare Research and Quality held a research meeting on using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data for quality improvement (QI) and evaluating such efforts. TOPICS COVERED. Meeting addressed: 1)What has been learned about organizational factors/environment needed to improve patient experience? 2)How have organizations used data to improve patient experience? 3)What can evaluations using CAHPS data teach us about implementing successful programs to improve patient experience? KEY THEMES Providers and stakeholders need to be engaged early and often, standardize QI processes, complement CAHPS data with other data, and compile dashboards of CAHPS scores to identify and track improvement. Rigorous study designs are valuable, but much can be learned and accomplished through practical organization-level studies.
Collapse
Affiliation(s)
- Denise Quigley
- RAND Corporation, Santa Monica, California, United States
| | - Nabeel Qureshi
- RAND Corporation, Santa Monica, California, United States
| | | | | | - Susan Edgman-Levitan
- John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital
| | | | - Caren Ginsberg
- Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | | |
Collapse
|
13
|
Meyers DJ, Rivera-Hernandez M, Kim D, Keohane LM, Mor V, Trivedi AN. Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias. J Am Geriatr Soc 2022; 70:2344-2353. [PMID: 35484976 DOI: 10.1111/jgs.17817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The Medicare Advantage (MA) program is rapidly growing. Limited evidence exists about the care experiences of MA beneficiaries with Alzheimer's Disease and Related Dementia (ADRD). Our objective was to compare care experiences for MA beneficiaries with and without ADRD. METHODS We examined MA beneficiaries who completed the Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) and used inpatient, nursing home, or home health services in the past 3 years. We classified beneficiaries with ADRD using the presence of diagnosis codes in hospitals, nursing homes, and home health records. Our key measures included overall ratings of care and health plan, and indices of receiving timely care, care coordination, receiving needed care, and customer service. We compared differences between beneficiaries with and without ADRD using regression analysis adjusting for demographic, health, and plan characteristics, and stratifying by proxy response status. RESULTS Among beneficiaries sampled by CAHPS, 22.2% with ADRD completed the survey compared to 38.5% without ADRD. Among proxy responses, beneficiaries with ADRD were 4.2 (95% CI: 0.1-8.4) percentage points less likely to report a high score for receiving needed care, and 3.5 percentage points (95% CI: 0.2-6.9) less likely to report a high score for customer service. Among non-proxy responses, those with ADRD were 9.0 (95% CI: 5.5-12.5) percentage points less likely to report a high score for needed care, and 8.5 (95% CI: 5.4-11.5) percentage points less likely to report a high score for customer service. CONCLUSIONS ADRD respondents to the CAHPS were more likely to be excluded from CAHPS performance measures because they did not meet eligibility requirements and rates of non-response were higher. Among responders with or without a proxy, MA enrollees with an ADRD diagnosis reported worse care experiences in receiving needed care and in customer service than those without an ADRD diagnosis.
Collapse
Affiliation(s)
- David J Meyers
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Daeho Kim
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laura M Keohane
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
14
|
Abstract
BACKGROUND There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender) might affect patient experiences. OBJECTIVE Assess whether patient experiences are more positive in gender concordant primary care relationships. DESIGN Statewide telephone surveys. Linear mixed regression models to estimate the association of CAHPS scores with patient gender and gender concordance. SUBJECTS Two probability samples of primary care Medicaid patients in Connecticut in 2017 (5/17-7/17) and 2019 (7/19-10/19). MAIN MEASURES Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey augmented with questions about aspects of care most salient to PCMH-designated organizations and two questions to assess access to mental health services. KEY RESULTS There were no significant effects of gender concordance and differences in experiences by patient gender were modest. CONCLUSIONS This study did not support the suggestion that patient and physician gender and gender concordance have an important effect on patient experiences.
Collapse
Affiliation(s)
| | - Eugenia Buta
- Yale Center for Analytical Studies, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
| | - Paul D Cleary
- Anna M.R. Lauder Professor of Public Health, Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| |
Collapse
|
15
|
Cai H, Fullam F, MacAllister L, Fogg LF, Canar J, Press I, Weissman C, Velasquez O. Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response. Int J Environ Res Public Health 2021; 18:9747. [PMID: 34574672 PMCID: PMC8469244 DOI: 10.3390/ijerph18189747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.
Collapse
Affiliation(s)
- Hui Cai
- Institute of Health and Wellness Design, Department of Architecture, The University of Kansas, Lawrence, KS 66047, USA;
| | - Francis Fullam
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | | | - Louis F. Fogg
- College of Nursing, Rush University, Chicago, IL 60612, USA;
| | - Jeff Canar
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | - Irwin Press
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
- Department of Anthropology, University of Notre Dame, Notre Dame, IN 46556, USA
| | | | | |
Collapse
|
16
|
DiMartino LD, Kirschner J, Jackson GL, Mollica MA, Lines LM. Are care experiences associated with survival among cancer patients? An analysis of the SEER- CAHPS data resource. Cancer Causes Control 2021; 32:977-987. [PMID: 34046807 DOI: 10.1007/s10552-021-01451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients' care experiences encompass the range of interactions with the health care system and are an important indicator of care quality, which may influence survival outcomes. This study evaluates relationships between care experiences and survival using a large, nationally representative sample of cancer patients. METHODS We used linked SEER (Surveillance Epidemiology and End Results)-CAHPS (Consumer Assessment of Healthcare Providers and Systems) data to identify people diagnosed 8/2006-12/2013, focusing on 10 solid tumor cancer sites with the highest mortality rates among those > 65. CAHPS measures included 5 global ratings and 3 composite scores. We used survey-weighted Cox proportional hazard models comparing survival time for those who had lower (0-8) vs higher ratings (9-10) and lower (0-89) vs higher (90-100) composite scores, adjusting for case-mix and additional covariates. RESULTS We identified 2,263 eligible people; 26% died by 5-year post-survey completion or end of follow-up (12/31/2017). We found lower Prescription Drug Plan (PDP) ratings were significantly associated with lower mortality (adjusted HR = 0.67, p = 0.03). Lower Getting Needed Care scores were also significantly associated with lower mortality (adjusted HR = 0.79, p = 0.04). For other care experience measures, general health status, cancer stage, and comorbidities were more predictive of survival (p < .05). CONCLUSIONS Except for PDP and Getting Needed Care, survival was similar for those with worse versus better care experiences. Patients with poorer cancer prognoses may perceive better services from their drug plan and more responsive care from clinical providers compared to those with better prognoses. Further research is needed examining processes underlying perceptions of care experiences and survival.
Collapse
Affiliation(s)
| | | | - George L Jackson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | - Lisa M Lines
- RTI International, Research Triangle Park, NC, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
17
|
Matar RN, Shah NS, Vincent JC, Rayos Del Sol S, Grawe BM. Factors that influence inpatient satisfaction after shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e165-e172. [PMID: 32750529 DOI: 10.1016/j.jse.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is important to distinguish satisfaction regarding the outcome of care and satisfaction with the delivery of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are modern assessments of hospitals and providers of delivery of care. The purpose of this study was to report inpatient satisfaction according to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) scores after shoulder arthroplasty and to determine factors that influence them, as well as their correlation with surgical expectations, pain perception, quality of life, surgical setting, and functional outcomes. METHODS All patients scheduled for a shoulder arthroplasty were prospectively asked to complete a demographic and initial shoulder assessment form, a shoulder surgery expectations survey, a pain catastrophizing scale, the SF-12 (12-item Short Form) survey, and a resiliency form (Resilience Scale 11). Patient satisfaction was measured with the CG-CAHPS and HCAHPS surveys. Legacy forms, patient-specific factors, type of surgery performed, location of surgery, length of hospital stay, and discharge disposition were evaluated on their ability to predict these survey scores. Linear regression was used to calculate correlations and predictions of continuous variables, and logistic regression was used to compared the satisfied vs. unsatisfied cohorts. RESULTS The average HCAHPS and CG-CAHPS satisfaction scores for the population were 74.7 ± 20.7 and 82.1 ± 19.4, respectively. Nonsmokers had a mean HCAHPS score of 77.7 ± 22.0, whereas current smokers reported a mean of 59.6 ± 5.2 (P = .03). Patients who were discharged home had a mean HCAHPS score of 77.3 ± 21.9, whereas those discharged to a skilled nursing facility reported a mean of 59.3 ± 6.6 (P = .05). These same groups also had significantly higher odds of being satisfied with the hospital. No significant differences or higher odds were seen for comparisons between overall CG-CAHPS satisfaction and any of the patient-specific factors tested. There was no significant correlation between age, length of stay, pain (pain catastrophizing scale), resiliency (Resilience Scale 11), expectations (shoulder surgery expectations survey), or function (SF-12) and both the HCAHPS and CG-CAHPS satisfaction scores. CONCLUSION Overall, 37 patients (74%) had CG-CAHPS scores that indicated satisfaction and 34 patients (68%) had HCAHPS scores that indicated satisfaction. Nonsmokers and patients discharged home after surgery report higher levels of inpatient hospital (HCAHPS) satisfaction after shoulder arthroplasty. Patients with high preoperative surgical expectations, pain perception, and resiliency are not generally more satisfied with the hospital or clinician. Preoperative diagnosis, location of surgery, and length of stay do not reliably impact satisfaction with the hospital or clinician. Inpatient HCAHPS and CG-CAHPS satisfaction does not correlate with legacy functional outcome measures and, therefore, may not be predictive of long-term functional outcomes.
Collapse
Affiliation(s)
- Robert N Matar
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jonathan C Vincent
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Shane Rayos Del Sol
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
18
|
Mohan CS, Rotter JS, Tan HJ, Kent E, Bjurlin MA, Basch E, Samuel C, Nielsen M, Smith AB. The association between patient experience and healthcare outcomes using SEER- CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2021; 12:623-31. [PMID: 33277226 DOI: 10.1016/j.jgo.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.
Collapse
|
19
|
Hays RD, Sherbourne CD, Spritzer KL, Hilton LG, Ryan GW, Coulter ID, Herman PM. Experiences With Chiropractic Care for Patients With Low Back or Neck Pain. J Patient Exp 2020; 7:357-364. [PMID: 32821795 PMCID: PMC7410126 DOI: 10.1177/2374373519846022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Musculoskeletal disorders are the second leading cause of disability worldwide. Objective Examine experiences of chiropractic patients in the United States with chronic low back or neck pain. Method Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care. Results We found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points). Conclusions The positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care.
Collapse
Affiliation(s)
- Ron D Hays
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA
| | | | - Karen L Spritzer
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA
| | - Lara G Hilton
- RAND Health, Santa Monica, CA, USA.,Deloitte Consulting LLP, Los Angeles, CA, USA
| | | | - Ian D Coulter
- RAND Health, Santa Monica, CA, USA.,UCLA School of Dentistry, Los Angeles, CA, USA
| | | |
Collapse
|
20
|
Fowler TT, Aiyelawo KM, Frazier C, Holden C, Dorris J. Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities. J Patient Exp 2020; 7:1234-1240. [PMID: 33457570 PMCID: PMC7786673 DOI: 10.1177/2374373520925275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care (p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care (p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.
Collapse
|
21
|
Dad T, Grobert ME, Richardson MM. Using Patient Experience Survey Data to Improve In-Center Hemodialysis Care: A Practical Review. Am J Kidney Dis 2020; 76:407-416. [PMID: 32199710 DOI: 10.1053/j.ajkd.2019.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
Patient experience is an integral aspect of the care we deliver to our dialysis patients. Standardized evaluation of patient experience with in-center hemodialysis started in the United States in 2012 with the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. Over time there have been a few changes to this survey, how it is administered, and how it fits within the Centers for Medicare & Medicaid Services End-Stage Renal Disease Quality Incentive Program. Although the importance of this survey has been growing, knowledge of this survey among nephrologists has lagged. We provide a review of the survey development and how its use has evolved since 2012. We discuss in detail research done on this survey to date, including survey psychometric evaluation. We highlight gaps in our knowledge that need further research and end with general recommendations to improve patient experience within hemodialysis facilities, which we believe is a worthy goal for all members of the dialysis team.
Collapse
|
22
|
Dad T, Tighiouart H, Lacson E, Meyer KB, Weiner DE, Richardson MM. Long-term Clinical Outcomes Among Responders and Nonresponders to the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey. Kidney Med 2020; 2:181-188. [PMID: 32734237 PMCID: PMC7380364 DOI: 10.1016/j.xkme.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Taimur Dad
- Tufts Medical Center, Boston, MA.,Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA
| | - Hocine Tighiouart
- Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.,Biostatistics, Epidemiology and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Eduardo Lacson
- Tufts Medical Center, Boston, MA.,Dialysis Clinic Incorporated, Nashville, TN
| | | | | | | |
Collapse
|
23
|
Moen EL, Bynum JPW. Evaluation of Physician Network-Based Measures of Care Coordination Using Medicare Patient-Reported Experience Measures. J Gen Intern Med 2019; 34:2482-9. [PMID: 31482341 DOI: 10.1007/s11606-019-05313-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/02/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is significant promise in analyzing physician patient-sharing networks to indirectly measure care coordination, yet it is unknown whether these measures reflect patients' perceptions of care coordination. OBJECTIVE To evaluate the associations between network-based measures of care coordination and patient-reported experience measures. DESIGN We analyzed patient-sharing physician networks within group practices using data made available by the Centers for Medicare and Medicaid Services. SUBJECTS Medicare beneficiaries who provided responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey in 2016 (data aggregated by physician group practice made available through the Physician Compare 2016 Group Public Reporting). MAIN MEASURES The outcomes of interest were patient-reported experience measures reflecting aspects of care coordination (CAHPS). The predictor variables of interests were physician group practice density (the number of physician pairs who share patients adjusting for the total number of physician pairs) and clustering (the extent to which sets of three physicians share patients). KEY RESULTS Four hundred seventy-six groups had patient-reported measures available. Patients' perception of "Clinicians working together for your care" was significantly positively associated with both physician group practice density (Est (95 % CI) = 5.07(0.83, 9.33), p = 0.02) and clustering (Est (95 % CI) = 3.73(1.01, 6.44), p = 0.007). Physician group practice clustering was also significantly positively associated with "Getting timely care, appointments, and information" (Est (95 % CI) = 4.63(0.21, 9.06), p = 0.04). CONCLUSIONS This work suggests that network-based measures of care coordination are associated with some patient-reported experience measures. Evaluating and intervening on patient-sharing networks may provide novel strategies for initiatives aimed at improving quality of care and the patient experience.
Collapse
|
24
|
Hargraves JL, Cosenza C, Elliott MN, Cleary PD. The effect of different sampling and recall periods in the CAHPS Clinician & Group (CG-CAHPS) survey. Health Serv Res 2019; 54:1036-1044. [PMID: 31132159 DOI: 10.1111/1475-6773.13173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- J Lee Hargraves
- Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts
| | | | - Paul D Cleary
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
25
|
MacCarthy S, Burkhart Q, Haviland AM, Dembosky JW, Wilson-Frederick S, Saliba D, Gaillot S, Elliott MN. Exploring Disparities in Influenza Immunization for Older Women. J Am Geriatr Soc 2019; 67:1268-1272. [PMID: 30990226 DOI: 10.1111/jgs.15887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/23/2019] [Accepted: 02/26/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults. DESIGN Nationally representative cross-sectional survey. SETTING United States. PARTICIPANTS A total of 1 252 705 adults, aged 65 years and older, responding to 2013 to 2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys. MEASUREMENTS The dependent variable was Healthcare Effectiveness Data and Information Set self-reported influenza immunization. The primary predictor was sex. Covariates included general health status, education, race/ethnicity, and Medicare Advantage (MA; managed care) vs Fee-for-Service (FFS) coverage. RESULTS After adjusting for health status and other sociodemographic factors, women's immunization was 2% lower than men's immunization in MA, with no significant overall sex difference in FFS. Women were immunized less often than men in 95% of MA health plans, with the largest gaps in low-immunizing plans. Further analyses revealed variation in sex differences by health status, education, and race/ethnicity in both MA and FFS. Notably in MA, women in poor health were immunized less often than men in similar health (-4%; P < .001). Black women were immunized much less often than black men in both MA and FFS (-5%; P < .001 for each). Hispanic women were immunized less often than Hispanic men in MA (-4%; P < .001) but not within FFS. CONCLUSION Women in MA experience small disparities overall in influenza immunization, with larger disparities for black and Hispanic women. Providers and MA plans should increase efforts to recommend and monitor immunization for older women, especially black and Hispanic women and those in poor health. Given the potential to reduce morbidity and mortality, equitable access to a critical preventive health service, such as influenza immunization, is crucial for all older adults.
Collapse
Affiliation(s)
| | - Q Burkhart
- RAND Corporation, Santa Monica, California
| | - Amelia M Haviland
- Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | - Debra Saliba
- RAND Corporation, Santa Monica, California.,Borun Center, University of California, Los Angeles.,Veterans Affairs Geriatric Research Education and Clinical Center, Los Angeles, California
| | - Sarah Gaillot
- Office of Minority Health, Centers for Medicare and Medicaid Services, Baltimore, Maryland.,Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | |
Collapse
|
26
|
Martino SC, Mathews M, Agniel D, Orr N, Wilson‐Frederick S, Ng JH, Ormson AE, Elliott MN. National racial/ethnic and geographic disparities in experiences with health care among adult Medicaid beneficiaries. Health Serv Res 2019; 54 Suppl 1:287-296. [PMID: 30628052 PMCID: PMC6341217 DOI: 10.1111/1475-6773.13106] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To investigate whether health care experiences of adult Medicaid beneficiaries differ by race/ethnicity and rural/urban status. DATA SOURCES A total of 270 243 respondents to the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems Survey. STUDY DESIGN Linear regression was used to estimate case mix adjusted differences in patient experience between racial/ethnic minority and non-Hispanic white Medicaid beneficiaries, and between beneficiaries residing in small urban areas, small towns, and rural areas vs large urban areas. Dependent measures included getting needed care, getting care quickly, doctor communication, and customer service. PRINCIPAL FINDINGS Compared with white beneficiaries, American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (API) beneficiaries reported worse experiences, while black beneficiaries reported better experiences. Deficits for AIAN beneficiaries were 6-8 points on a 0-100 scale; deficits for API beneficiaries were 13-22 points (P's < 0.001); advantages for black beneficiaries were 3-5 points (P's < 0.001). Hispanic white differences were mixed. Beneficiaries in small urban areas, small towns, and isolated rural areas reported significantly better experiences (2-3 points) than beneficiaries in large urban areas (P's < 0.05), particularly regarding access to care. Racial/ethnic differences typically did not vary by geography. CONCLUSIONS Improving experiences for racial/ethnic minorities and individuals living in large urban areas should be high priorities for policy makers exploring approaches to improve the value and delivery of care to Medicaid beneficiaries.
Collapse
Affiliation(s)
| | | | | | - Nate Orr
- RAND CorporationSanta MonicaCalifornia
| | | | - Judy H. Ng
- National Committee for Quality AssuranceWashingtonDistrict of Columbia
| | | | | |
Collapse
|
27
|
Fowler FJ, Cosenza C, Cripps LA, Edgman-Levitan S, Cleary PD. The effect of administration mode on CAHPS survey response rates and results: A comparison of mail and web-based approaches. Health Serv Res 2019; 54:714-721. [PMID: 30656646 DOI: 10.1111/1475-6773.13109] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare response rates, respondents' characteristics, and substantive results for CAHPS surveys administered using web and mail protocols. DATA SOURCES Patients who had one or more primary care visits in the preceding 6 months. STUDY DESIGN/DATA COLLECTION METHODS Patients for whom primary care practices had email addresses were randomized to one of four survey administration protocols: web via a portal invitation; web via an email invitation; combination of web and mail; and mail only. Another sample of patients without known email addresses was surveyed by mail. Samples of nonrespondents to the Internet and mail protocols were surveyed by telephone. PRINCIPAL FINDINGS Response rates to surveys administered using the Internet protocols were lower than for the surveys administered by mail (20 percent vs over 40 percent). However, characteristics of respondents and survey answers were very similar across protocols. Respondents without email addresses were older, less educated, and more likely to be male than those with email addresses, and there were a few differences in their responses. There was little evidence of nonresponse bias in either the mail or web protocols. CONCLUSION In this well-educated patient population, web protocols had lower response rates, but substantive results very similar to those from mail protocols.
Collapse
Affiliation(s)
- Floyd J Fowler
- Center for Survey Research, UMass Boston, Boston, Massachusetts
| | - Carol Cosenza
- Center for Survey Research, UMass Boston, Boston, Massachusetts
| | - Lauren A Cripps
- Healthcare Research in Pediatrics, Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Susan Edgman-Levitan
- John D Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul D Cleary
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
28
|
Dad T, Tighiouart H, Lacson E, Meyer KB, Weiner DE, Richardson MM. Hemodialysis patient characteristics associated with better experience as measured by the In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. BMC Nephrol 2018; 19:340. [PMID: 30486811 PMCID: PMC6264620 DOI: 10.1186/s12882-018-1147-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/21/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient 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. METHODS This 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). RESULTS Among 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. CONCLUSIONS Several 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.
Collapse
Affiliation(s)
- Taimur Dad
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, USA
| | - Hocine Tighiouart
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA USA
- Biostatistics, Epidemiology and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA USA
| | - Eduardo Lacson
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Dialysis Clinic Incorporated, Nashville, TN USA
| | - Klemens B. Meyer
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
| | - Daniel E. Weiner
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
| | | |
Collapse
|
29
|
Dad T, Tighiouart H, Fenton JJ, Lacson E, Meyer KB, Miskulin DC, Weiner DE, Richardson MM. Evaluation of non-response to the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. BMC Health Serv Res 2018; 18:790. [PMID: 30340585 PMCID: PMC6194668 DOI: 10.1186/s12913-018-3618-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022] Open
Abstract
Background The 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. Methods Cross-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. Results Among 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. Conclusions Non-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. Electronic supplementary material The online version of this article (10.1186/s12913-018-3618-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Taimur Dad
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA.
| | - Hocine Tighiouart
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Biostatistics, Epidemiology and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Joshua J Fenton
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Eduardo Lacson
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA.,Dialysis Clinic Incorporated, Nashville, TN, USA
| | - Klemens B Meyer
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - Dana C Miskulin
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - Daniel E Weiner
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - Michelle M Richardson
- Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| |
Collapse
|
30
|
Abstract
The Dialysis Facility Compare Star Rating and the Quality Incentive Program (QIP) generate separate performance scores from clinical measures, and the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey evaluates patient satisfaction across 6 separate domains related to nephrologists, dialysis facility, and information transmission. This study examined the relationship of the 3 measures for US clinics, modeling the 6 ICH-CAHPS domains as independent variables and QIP and star ratings as dependent variables. Among 3176 dialysis clinics, domains assessing dialysis facility and information transmission had a consistently stronger relationship with QIP and star ratings than the domains assessing nephrologists: QIP, β (95% CI) = 1.62 (1.26-1.97) for dialysis facility staff rating, 0.70 (0.35-1.05) for nephrologists; star rating, odds ratio (95% CI) = 1.38 (1.29-1.49) for dialysis facility staff rating, 1.17 (1.09-1.25) for nephrologists. Patient satisfaction is associated with dialysis care quality, with surprising differences between nephrologists and dialysis facilities.
Collapse
|
31
|
Abstract
The National Academy of Medicine’s (NAM) vision for 21st-century health care underscored the need for increased patient engagement and charged health-care researchers to develop tools to evaluate patient experience. The most widely studied patient experience tools are the Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. The Clinician and Group (CG)-CAHPS survey is the preferred patient experience survey for primary care, and thus a systematic review of patient reports from the CG-CAHPS empirical literature is ideal to appreciate the voice of health-care consumers. This systematic review revealed patient subjective reports regarding the acceptability of health-care delivery models, the effectiveness of interventions, the timeliness of care in different practice climates, and their responses to quality improvement initiatives. The synthesized results inform clinicians, organizations, and the health-care system where to prioritize and how to adapt services to efficiently provide equitable care, achieving the NAM’s vision for a patient-centered US health-care system.
Collapse
Affiliation(s)
- Jeana M Holt
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI, USA.,Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
32
|
Price RA, Parast L, Haas A, Teno JM, Elliott MN. Black And Hispanic Patients Receive Hospice Care Similar To That Of White Patients When In The Same Hospices. Health Aff (Millwood) 2018; 36:1283-1290. [PMID: 28679816 DOI: 10.1377/hlthaff.2017.0151] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little is known about racial and ethnic variation in the quality of hospice care. We used data on 292,516 respondents for 2015-16 from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to assess how the patient and family experience of hospice care differed among black, Hispanic, and white patients. We found that, on average, black and Hispanic patients received care from poorer quality hospices. Within a given hospice, we found that friends and relatives who served as caregivers of black and Hispanic patients reported significantly better hospice care experiences than their peers serving as caregivers of white patients on five of seven outcomes. However, caregivers of black and Hispanic patients reported receiving their desired level of emotional and religious support less often than caregivers of white patients did. As more black and Hispanic patients enroll in hospice care, it is critical to ensure that they have access to high-quality, culturally competent hospice services.
Collapse
Affiliation(s)
- Rebecca Anhang Price
- Rebecca Anhang Price is a senior policy researcher at the RAND Corporation in Arlington, Virginia
| | - Layla Parast
- Layla Parast is a statistician at the RAND Corporation in Santa Monica, California
| | - Ann Haas
- Ann Haas is a statistical analyst at the RAND Corporation in Pittsburgh, Pennsylvania
| | - Joan M Teno
- Joan M. Teno is a professor in the Cambia Palliative Care Center of Excellence, Division of Gerontology and Geriatric Medicine, Department of Medicine, at the University of Washington, in Seattle
| | - Marc N Elliott
- Marc N. Elliott is a senior principal researcher and holds the Chair in Statistics at the RAND Corporation in Santa Monica
| |
Collapse
|
33
|
Halpern MT, Urato MP, Lines LM, Cohen JB, Arora NK, Kent EE. Healthcare experience among older cancer survivors: Analysis of the SEER- CAHPS dataset. J Geriatr Oncol 2018; 9:194-203. [PMID: 29249645 PMCID: PMC6002869 DOI: 10.1016/j.jgo.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/29/2017] [Accepted: 11/09/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Little is known about factors affecting medical care experiences of cancer survivors. This study examined experience of care among cancer survivors and assessed associations of survivors' characteristics with their experience. MATERIALS AND METHODS We used a newly-developed, unique data resource, SEER-CAHPS (NCI's Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey responses), to examine experiences of care among breast, colorectal, lung, and prostate cancer survivors age >66years who completed CAHPS >1year after cancer diagnosis and survived ≥1year after survey completion. Experience of care was assessed by survivor-provided scores for overall care, health plan, physicians, customer service, doctor communication, and aspects of care. Multivariable logistic regression models assessed associations of survivors' sociodemographic and clinical characteristics with care experience. RESULTS Among 19,455 cancer survivors with SEER-CAHPS data, higher self-reported general-health status was significantly associated with better care experiences for breast, colorectal, and prostate cancer survivors. In contrast, better mental-health status was associated with better care experience for lung cancer survivors. College-educated and Asian survivors were less likely to indicate high scores for care experiences. Few differences in survivors' experiences were observed by sex or years since diagnosis. CONCLUSIONS The SEER-CAHPS data resources allows assessment of factors influencing experience of cancer among U.S. cancer survivors. Higher self-reported health status was associated with better experiences of care; other survivors' characteristics also predicted care experience. Interventions to improve cancer survivors' health status, such as increased access to supportive care services, may improve experience of care.
Collapse
Affiliation(s)
- Michael T Halpern
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA; Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122, USA.
| | - Matthew P Urato
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Lisa M Lines
- RTI International, 307 Waverley Oaks Road, Suite 101,Waltham, MA 02452, USA
| | - Julia B Cohen
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Neeraj K Arora
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Suite 900, Washington, DC 20036, USA
| | - Erin E Kent
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| |
Collapse
|
34
|
Sarinopoulos I, Bechel-Marriott DL, Malouin JM, Zhai S, Forney JC, Tanner CL. Patient Experience with the Patient-Centered Medical Home in Michigan's Statewide Multi-Payer Demonstration: A Cross-Sectional Study. J Gen Intern Med 2017; 32:1202-1209. [PMID: 28808852 PMCID: PMC5653555 DOI: 10.1007/s11606-017-4139-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 04/11/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature on patient-centered medical homes (PCMHs) and patient experience is somewhat mixed. Government and private payers are promoting multi-payer PCMH initiatives to align requirements and resources and to enhance practice transformation outcomes. To this end, the multipayer Michigan Primary Care Transformation (MiPCT) demonstration project was carried out. OBJECTIVE To examine whether the PCMH is associated with a better patient experience, and whether a mature, multi-payer PCMH demonstration is associated with even further improvement in the patient experience. DESIGN This is a cross-sectional comparison of adults attributed to MiPCT PCMH, non-participating PCMH, and non-PCMH practices, statistically controlling for potential confounders, and conducted among both general and high-risk patient samples. PARTICIPANTS Responses came from 3893 patients in the general population and 4605 in the high-risk population (response rates of 31.8% and 34.1%, respectively). MAIN MEASURES The Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey, with PCMH supplemental questions, was administered in January and February 2015. KEY RESULTS MiPCT general and high-risk patients reported a significantly better experience than non-PCMH patients in most domains. Adjusted mean differences were as follows: access (0.35**, 0.36***), communication (0.19*, 0.18*), and coordination (0.33**, 0.35***), respectively (on a 10-point scale, with significance indicated by: *= p<0.05, **= p<0.01, and ***= p<0.001). Adjusted mean differences in overall provider ratings were not significant. Global odds ratios were significant for the domains of self-management support (1.38**, 1.41***) and comprehensiveness (1.67***, 1.61***). Non-participating PCMH ratings fell between MiPCT and non-PCMH across all domains and populations, sometimes attaining statistical significance. CONCLUSIONS PCMH practices have more positive patient experiences across domains characteristic of advanced primary care. A mature multi-payer model has the strongest, most consistent association with a better patient experience, pointing to the need to provide consistent expectations, resources, and time for practice transformation. Our results held for a general population and a high-risk population which has much more contact with the healthcare system.
Collapse
Affiliation(s)
| | | | - Jean M Malouin
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shaohui Zhai
- Michigan Public Health Institute, Okemos, MI, USA
| | | | - Clare L Tanner
- Michigan Public Health Institute, Okemos, MI, USA. .,Center for Data Management and Translational Research, Michigan Public Health Institute, 2501 Jolly Road, Suite 180, Okemos, MI, USA.
| |
Collapse
|
35
|
Magwene EM, Quiñones AR, Marshall GL, Makaroun LK, Thielke S. Older adults rate their mental health better than their general health. J Public Health Res 2017; 6:967. [PMID: 29071258 PMCID: PMC5641665 DOI: 10.4081/jphr.2017.967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/11/2017] [Indexed: 11/28/2022] Open
Abstract
Background. Self-rated health (SRH) shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH) as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics. Design and methods. We analyzed data from the 2012 CAHPS Medicare Advantage Survey. SRH and SRMH ratings were crosstabulated to determine the distribution of responses across response categories. The expected joint probability distribution was computed and compared to the observed distribution. A constructed variable indicated whether SRMH was better, the same, or worse than SRH. We analyzed the distribution of this variable across various subgroups defined by sociodemographic and health-related factors. Results. A total of 114,905 Medicare Advantage beneficiaries responded to both the SRH and SRMH questions. Both in general and within all subgroups, SRMH was usually rated as better than SRH, and rarely as worse. Conclusions. Within a large group of Medicare recipients, the overwhelming trend was for recipients to rate their mental health as at least as good as their overall health, regardless of any sociodemographic and health-related factors. This finding of a shifted distribution encourages caution in the analytic use of selfrated mental health, particularly the use of both SRH and SRMH for adjustment. Additional research is needed to help clarify the complex relationship between these variables. Significance for public health Self-rated health (SRH) has become established as a general measure of health status, but less is known about self-rated mental health (SRMH). Recent epidemiological studies have included self-rated mental health (SRMH) without scrutinizing its properties and in particular its relationship with SRH. In a large dataset of Medicare recipients, we found that self-rated mental health was consistently rated better than self-rated health, across all patient groups. None of the sociodemographic or health factors we examined accounted for this discrepancy. Self-rated mental health seemed to be more resistant to the effects of medical illnesses and functional impairments than was self-rated health. This points to a likely difference in how people formulate and differentiate between their mental and general health, with mental health being seen as more separate from other health factors. These findings encourage caution in the use of SRMH in analytic models, especially if included simultaneously with SRH.
Collapse
Affiliation(s)
- Elena M Magwene
- Mental Health Service, VA Puget Sound Health Care System, Seattle, WA
| | | | | | - Lena K Makaroun
- University of Washington, Seattle, WA.,VA Health Services Research and Development, VA Puget Sound Healthcare System, Seattle, WA
| | - Stephen Thielke
- University of Washington, Seattle, WA.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| |
Collapse
|
36
|
Smith LM, Anderson WL, Lines LM, Pronier C, Thornburg V, Butler JP, Teichman L, Dean-Whittaker D, Goldstein E. Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance. Home Health Care Serv Q 2017; 36:29-45. [PMID: 28448222 DOI: 10.1080/01621424.2017.1320698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined the effects of provider characteristics on home health agency performance on patient experience of care (Home Health CAHPS) and process (OASIS) measures. Descriptive, multivariate, and factor analyses were used. While agencies score high on both domains, factor analyses showed that the underlying items represent separate constructs. Freestanding and Visiting Nurse Association agencies, higher number of home health aides per 100 episodes, and urban location were statistically significant predictors of lower performance. Lack of variation in composite measures potentially led to counterintuitive results for effects of organizational characteristics. This exploratory study showed the value of having separate quality domains.
Collapse
Affiliation(s)
- Laura M Smith
- a RTI International , eHealth, Quality and Analytics , Waltham , Massachusetts , USA
| | - Wayne L Anderson
- b RTI International , Aging, Disability and Long-Term Care , Research Triangle Park , North Carolina , USA
| | - Lisa M Lines
- c RTI International , Center for Advanced Methods Development , Waltham , Massachusetts , USA
| | - Cristalle Pronier
- d RTI International , Survey Research Division , Research Triangle Park , North Carolina , USA
| | - Vanessa Thornburg
- d RTI International , Survey Research Division , Research Triangle Park , North Carolina , USA
| | - Janelle P Butler
- d RTI International , Survey Research Division , Research Triangle Park , North Carolina , USA
| | - Lori Teichman
- e Centers for Medicare & Medicaid Services , Baltimore , Maryland , USA
| | | | | |
Collapse
|
37
|
Setodji CM, Quigley DD, Elliott MN, Burkhart Q, Hochman ME, Chen AY, Hays RD. Patient Experiences with Care Differ with Chronic Care Management in a Federally Qualified Community Health Center. Popul Health Manag 2017; 20:442-448. [PMID: 28387598 DOI: 10.1089/pop.2017.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study compares patient experience among practices that vary in adoption of the chronic care management (CCM) dimension of the patient-centered medical home (PCMH) model that focuses on care coordination and management of chronic diseases. Study participants were 2903 adult patients (ages 18 years or older) at 14 primary care centers in California. Seven of the sites were classified as high (more CCM) and the other 7 low on a CCM index. Hypotheses were tested using ordinary least squares regression models. After adjusting for the number of providers at the sites, high CCM scores were associated with significantly better overall ratings of providers, provider communication, follow-up on test results, and willingness to recommend the provider (differences of 5.82, 6.85, 9.81, and 4.56, respectively on the 0-100 scale scores). The results of this study provide support for the value of the PCMH for patient experiences with care.
Collapse
Affiliation(s)
- Claude M Setodji
- 1 RAND Center for Causal Inference , RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | - Q Burkhart
- 2 RAND Corporation , Santa Monica, California
| | - Michael E Hochman
- 3 Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Alex Y Chen
- 4 AltaMed Health Services , Los Angeles, California
| | - Ron D Hays
- 2 RAND Corporation , Santa Monica, California.,5 Division of General Internal Medicine & Health Services Research , Department of Medicine, UCLA, Los Angeles, California
| |
Collapse
|
38
|
Smith SA, Yount N, Sorra J. Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. BMC Health Serv Res 2017; 17:143. [PMID: 28209151 PMCID: PMC5314608 DOI: 10.1186/s12913-017-2078-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background A number of private and public companies calculate and publish proprietary hospital patient safety scores based on publicly available quality measures initially reported by the U.S. federal government. This study examines whether patient safety culture perceptions of U.S. hospital staff in a large national survey are related to publicly reported patient safety ratings of hospitals. Methods The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (Hospital SOPS) assesses provider and staff perceptions of hospital patient safety culture. Consumer Reports (CR), a U.S. based non-profit organization, calculates and shares with its subscribers a Hospital Safety Score calculated annually from patient experience survey data and outcomes data gathered from federal databases. Linking data collected during similar time periods, we analyzed relationships between staff perceptions of patient safety culture composites and the CR Hospital Safety Score and its five components using multiple multivariate linear regressions. Results We analyzed data from 164 hospitals, with patient safety culture survey responses from 140,316 providers and staff, with an average of 856 completed surveys per hospital and an average response rate per hospital of 56%. Higher overall Hospital SOPS composite average scores were significantly associated with higher overall CR Hospital Safety Scores (β = 0.24, p < 0.05). For 10 of the 12 Hospital SOPS composites, higher patient safety culture scores were associated with higher CR patient experience scores on communication about medications and discharge. Conclusion This study found a relationship between hospital staff perceptions of patient safety culture and the Consumer Reports Hospital Safety Score, which is a composite of patient experience and outcomes data from federal databases. As hospital managers allocate resources to improve patient safety culture within their organizations, their efforts may also indirectly improve consumer-focused, publicly reported hospital rating scores like the Consumer Reports Hospital Safety Score.
Collapse
Affiliation(s)
| | - Naomi Yount
- Westat, 1600 Research Blvd, Rockville, MD, 20850, USA
| | - Joann Sorra
- Westat, 1600 Research Blvd, Rockville, MD, 20850, USA
| |
Collapse
|
39
|
Martino SC, Shaller D, Schlesinger M, Parker AM, Rybowski L, Grob R, Cerully JL, Finucane ML. CAHPS and Comments: How Closed-Ended Survey Questions and Narrative Accounts Interact in the Assessment of Patient Experience. J Patient Exp 2017; 4:37-45. [PMID: 28725858 PMCID: PMC5513663 DOI: 10.1177/2374373516685940] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives: To investigate whether content from patient narratives explains variation in patients’ primary care provider (PCP) ratings beyond information from the closed-ended questions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores. Methods: Members of a standing Internet panel (N = 332) were randomly assigned to complete a CAHPS survey that was either preceded or followed by a set of open-ended questions about how well their PCP meets their expectations and how they relate to their PCP. Results: Narrative content from healthier patients explained only an additional 2% beyond the variation in provider ratings explained by CAHPS composite measures. Among sicker patients, narrative content explained an additional 10% of the variation. The relative placement of closed- and open-ended questions had little impact on narratives or CAHPS scores. Conclusion: Incorporating a protocol for eliciting narratives into a patient experience survey results in minimal distortion of patient feedback. Narratives from sicker patients help explain variation in provider ratings.
Collapse
Affiliation(s)
| | | | - Mark Schlesinger
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
| | | | | | - Rachel Grob
- Center for Patient Partnerships, University of Wisconsin Law School, Madison, WI, USA.,Department of Family Medicine, University of Wisconsin Medical School, Madison, WI, USA
| | | | | |
Collapse
|
40
|
Hays RD, Chawla N, Kent EE, Arora NK. Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems ( CAHPS®) Medicare survey items between Whites and Asians. Qual Life Res 2017; 26:311-8. [PMID: 27495274 DOI: 10.1007/s11136-016-1383-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. We examined responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items by Whites and Asians, controlling for underlying level on the CAHPS constructs. METHODS We conducted multiple group analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled data from 2007 to 2011. Responses were obtained from 1,326,410 non-Hispanic Whites and 40,672 non-Hispanic Asians (hereafter referred to as Whites and Asians). The median age for Whites was 70, with 24 % 80 or older, and 70 for Asians, with 23 % 80 or older. Fifty-eight percent of Whites and 56 % of Asians were female. RESULTS A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates (7 factor loadings, 3 measured variable errors, and 2 item intercepts): Comparative Fit Index = 0.947 and 0.948; root-mean-square error of approximation = 0.052 and 0.052, respectively). Differences in latent CAHPS score means between Whites and Hispanics estimated from the two models were similar, differing by 0.053 SD or less. CONCLUSIONS This study provides support for measurement equivalence of the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparisons of care experiences between the two groups.
Collapse
|
41
|
Cleary PD. Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition. J Health Polit Policy Law 2016; 41:675-696. [PMID: 27127265 DOI: 10.1215/03616878-3620881] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In his seminal work on health care quality, Avedis Donabedian noted that patient satisfaction was a key indicator of health care quality, and in the 1970s and 1980s a great deal of research explored the determinants of patient satisfaction. Subsequently, attention shifted toward assessing care experiences, and there is now a large body of evidence related to the reliability and validity of survey-based assessments of care. As the use of such surveys has increased, so too have concerns about the validity and uses of such surveys. The available research, however, indicates that such surveys are reliable, valid, correlated across individuals and settings with other quality indicators, and predictive of better outcomes. Patient experiences are now routinely measured, and substantial effort is being devoted to providing high-quality patient-centered care. Providing patient-centered care need not divert resources away from other quality improvement efforts. Improving the infrastructure supporting certain aspects of care may have broad effects because system changes can influence multiple outcomes. Thus, rather than detract from general quality improvement efforts, making changes that facilitate patient-centered care may lead to broader improvements. There is good reason to be optimistic that our health care system will increasingly be "patient centered."
Collapse
|
42
|
Jiang N, Malkin BD. Use of Lean and CAHPS Surgical Care Survey to Improve Patients' Experiences with Surgical Care. Otolaryngol Head Neck Surg 2016; 155:743-747. [PMID: 27329420 DOI: 10.1177/0194599816657051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) Measure patients' experiences with surgical care using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey. (2) Use lean thinking to analyze and improve quality of patient care. STUDY DESIGN A prospective quality improvement study. SETTING Hospital-based otolaryngology clinic. SUBJECTS AND METHODS The CAHPS Surgical Care Survey was distributed to 17 surgical patients to determine their perception of the current state of care. Survey results were analyzed with lean thinking, and changes were made to improve critical areas. A second set of surveys was distributed to 10 patients to assess the success of the interventions immediately and 2 months later. The data were analyzed with the Mann-Whitney U test. RESULTS Seventeen patients completed the CAHPS Surgical Care Survey to determine the initial state. A3 Thinking was used to analyze the results and design an improvement. Overall positive patient experience was 57% at the postoperative visit with 3 key aspects of care: time spent during visit, encouragement to ask questions, show of respect to the patient. Two causes were postulated; then, solution approaches were developed and tested in a series of rapid experiments. Two groups of 10 patients completed the CAHPS Surgical Care Survey to determine the postintervention state. Overall positive patient experience significantly improved to 93% (U = 474, P < .001) and 83% (U = 546, P = .009) immediately and 2 months later, respectively. CONCLUSION Lean thinking helps to eliminate defects by breaking down complex problem solving into a scientific process. When combined with the CAHPS Surgical Care Survey, it can be successfully used to improve patients' surgical experiences.
Collapse
Affiliation(s)
- Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| | - Benjamin D Malkin
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| |
Collapse
|
43
|
Martino SC, Elliott MN, Haviland AM, Saliba D, Burkhart Q, Kanouse DE. Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service. Health Serv Res 2015; 51:1002-20. [PMID: 26368572 DOI: 10.1111/1475-6773.12359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). DATA SOURCES Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. STUDY DESIGN Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). PRINCIPAL FINDINGS Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. CONCLUSIONS Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment.
Collapse
Affiliation(s)
| | | | | | - Debra Saliba
- UCLA, JH Borun Center and Los Angeles Veterans Administration Health System, Los Angeles, CA
| | | | | |
Collapse
|
44
|
Franck LS, Ferguson D, Fryda S, Rubin N. The Child and Family Hospital Experience: Is It Influenced by Family Accommodation? Med Care Res Rev 2015; 72:419-37. [PMID: 25854957 PMCID: PMC4512521 DOI: 10.1177/1077558715579667] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/07/2015] [Indexed: 11/17/2022]
Abstract
Patient and family experiences are important indicators of quality of care and little is known about how family accommodation affects hospital experience. We added questions about accommodation to standardized inpatient pediatric and neonatal intensive care unit family experience surveys at 10 U.S. hospitals to determine the accommodation types used by families, compare characteristics across accommodation types and explore accommodation-type influences on overall hospital experience outcomes. Parents of inpatient children (n = 5,105; 93.4%) most often stayed in the child’s room (76.8%). Parents of neonatal intensive care unit infants (n = 362; 6.6%) most often stayed overnight in their own home or with relatives/friends (47.2%). Accommodation varied based on hospital, parent, and child factors. Accommodation type was a significant predictor for most hospital experience outcomes, with families who stayed at a Ronald McDonald House reporting more positive overall hospital experiences (odds ratios: ranging from 1.83 to 4.86 for contrasted accommodation types and three experience outcomes).
Collapse
Affiliation(s)
| | | | - Sarah Fryda
- National Research Corporation, Lincoln, NE, USA
| | | |
Collapse
|
45
|
Weech-Maldonado R, Elliott MN, Adams JL, Haviland AM, Klein DJ, Hambarsoomian K, Edwards C, Dembosky JW, Gaillot S. Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups? Health Serv Res 2015; 50:1829-49. [PMID: 25757356 DOI: 10.1111/1475-6773.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans. DATA SOURCES/STUDY SETTING 5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data. STUDY DESIGN Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures. PRINCIPAL FINDINGS Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/.21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API. CONCLUSIONS Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures.
Collapse
Affiliation(s)
- Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
| | | | - John L Adams
- Center for Effectiveness and Research, Kaiser Permanente, Pasadena, CA
| | - Amelia M Haviland
- H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA
| | - David J Klein
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | | | | | | | - Sarah Gaillot
- Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD
| |
Collapse
|
46
|
Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014; 71:522-54. [PMID: 25027409 DOI: 10.1177/1077558714541480] [Citation(s) in RCA: 485] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.
Collapse
Affiliation(s)
| | | | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
47
|
Drake KM, Hargraves JL, Lloyd S, Gallagher PM, Cleary PD. The effect of response scale, administration mode, and format on responses to the CAHPS Clinician and Group survey. Health Serv Res 2014; 49:1387-99. [PMID: 24471975 DOI: 10.1111/1475-6773.12160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine how different response scales, methods of survey administration, and survey format affect responses to the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Clinician and Group (CG-CAHPS) survey. STUDY DESIGN A total of 6,500 patients from a university health center were randomly assigned to receive the following: standard 12-page mail surveys using 4-category or 6-category response scales (on CG-CAHPS composite items), telephone surveys using 4-category or 6-category response scales, or four-page mail surveys. PRINCIPAL FINDINGS A total of 3,538 patients completed surveys. Composite score means and provider-level reliabilities did not differ between respondents receiving 4-category or 6-category response scale surveys or between 12-page and four-page mail surveys. Telephone respondents gave more positive responses than mail respondents. CONCLUSIONS We recommend using 4-category response scales and the four-page mail CG-CAHPS survey.
Collapse
Affiliation(s)
- Keith M Drake
- Health Care division of Greylock McKinnon Associates, Cambridge, MA
| | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Maged K Rizk
- Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio.
| | | | | |
Collapse
|