Consumer Assessment of Healthcare Providers and Systems CAHPS Clinician and Group Adult Visit Survey September 11 2012 Naomi Dyer PhD Joann Sorra PhD Scott Smith PhD Westat Paul Cleary PhD Yale ID: 194647
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Slide1
Psychometric Properties of the
Consumer
Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Adult Visit Survey
September 11, 2012
Naomi Dyer, PhD,
Joann Sorra
, PhD, Scott Smith, PhD, Westat
Paul Cleary, PhD, Yale
Ron Hays, PhD, RANDSlide2
CAHPS is a multiyear initiative of AHRQ to support and promote the assessment of consumers’ experiences with health care
Numerous CAHPS surveys have been created for different health care settings such as :
Health Plan
Surgical Care
Home Health CareHospitalIn-center HemodialysisNursing HomeClinician & Group
BackgroundSlide3
Westat, under contract with AHRQ, houses the database for Clinician and Group CAHPS (CG-CAHPS) and reports on these data
BackgroundSlide4
There are several CG-CAHPS Surveys:
CG-CAHPS 12-month Survey (Adult and Child)
CG-CAHPS
12
month Survey with Patient-Centered Medical HomeCG-CAHPS Visit Survey (Adult and Child)CG-CAHPS Database is the newest component of the CAHPS DatabasesThe CG-CAHPS Adult Visit Survey database received the most data in 2011
BackgroundSlide5
The CG-CAHPS
Visit
surveys were created to allow patients to report on and evaluate their experiences during their most recent outpatient medical visitThe 12 month versions ask about their experiences in
the
previous yearSurveys and related material available at:http://cahps.ahrq.gov/clinician_group/
BackgroundSlide6
Goal: Develop a survey
to assess patients' experiences with medical groups and clinicians.
Development of the Visit Survey began in 2008Field testing in 2009 to compare with the 12-month survey versionResults led to the Access to Care items in the survey reverting to a 12-month reference period rather than visit-specific
Survey DevelopmentSlide7
CG-CAHPS Composites
3 composites
1. Access to Care (5 items)2. Doctor Communication (6 items)3. Courteous/Helpful Staff (2 items) 2 overall rating items1. Overall Doctor Rating (11-point scale; 0 = “Worst doctor possible”,
10 =
“Best doctor possible”)2. Recommend the Doctor’s Office to family and friends (3-point scale; “No” to “Yes, definitely”)Various socio-demographics including overall health, age, gender, and educationSlide8
Access to Care Composite
All 5 items reference a 12-month period
4-point scale (1 = Never, 2 = Sometimes, 3 = Usually, 4 =Always
)Slide9
Access to Care Composite
In the last 12 months,
How often did you get an appointment for care you needed right away as soon as you needed?
How
often did you get an appointment for routine care as soon as you needed?When you phoned this doctor’s office during regular office hours, how often did you get an answer to your medical question that same day? When you phoned this doctor’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? How often did you see this doctor within 15 minutes of your appointment time? Slide10
Doctor Communication Composite
All six items reference
the most recent office visit3-point scale (1 = Yes, definitely; 2 = Yes, somewhat; 3 = No)
During your most recent visit, did this doctor…
Explain things in a way that was easy to understand?Listen carefully to you?Give you easy to understand information about your health questions or concerns? Seem to know the important information about your medical history?Show respect for what you had to say
?Slide11
Courteous/Helpful Staff Composite
Both items reference the office visit
3-point scale (1 = Yes, definitely; 2 = Yes, somewhat; 3 = No)
During your most recent visit
, were clerks and receptionists at this doctor’s office…As helpful as you thought they should be? Treat you with courtesy and respect? Slide12
CG-CAHPS Analysis Dataset
Adult Visit Survey Data from the CG-CAHPS Comparative Database103,442 responses
469 practice sitesThere were 5 screener questions that determined if the composite item was to be answered by respondents 4 screener questions for Access to Care1 screen question Doctor CommunicationOnly
non-missing data for the composite items were included in the analysisSlide13
CG-CAHPS Analysis Dataset
93% of respondents did not phone their doctor after regular hours Because of the high percentage of skips, “How
often did you get an appointment for care you needed right away as soon as you needed?” was dropped from analysis Remaining 4 Access to Care composite items had responses between 46% to 98% of respondents Final CG-CAHPS Analysis Dataset450 practice sites21,318 responsesSlide14
Characteristics of Analysis Dataset
All respondents received paper/mail surveys
89% of sites were Family Practice or Internal Medicine69% of sites were owned by a hospital or integrated delivery system67% of respondents were female;
81
% were 45 years or olderSlide15
Psychometric Analyses and Criterion
Individual and Multilevel Confirmatory Factor Analysis (CFA
)Factor loadings above 0.40Acceptable model fit indices CFI > 0.95 RMSEA < 0.06 SRMR < 0.08 (Individual, Between- and Within-)Individual Internal Consistency Reliability AnalysisCronbach’s α ≥ 0.70 Slide16
Psychometric Analyses and Criterion
Practice Site Reliability AnalysisReliability ≥ 0.70
Examined reliability by practice size categories1 clinician2 to 3 clinicians4-9 clinicians10-13 clinicians14-19 clinicians20 or more clinicians
Correlation analysis among the composites and global ratings
Individual and practice site levelsSlide17
Individual Level CFA Results
All items within composites had individual factor loadings above 0.40 with average loadings ofAccess to Care: 0.68
Doctor Communication: 0.76Courteous/Helpful Staff: 0.86All model fit indices met criteriaCFI: 0.97RMSEA: 0.05SRMR: 0.04Slide18
Multilevel CFA Results
All items at practice site level had factor loadings above 0.40
Between site factor loadings range: 0.59 to 0.99Within site factor loadings rage: 0.45 to 0.99All model fit indices met criteria except between-practice site SRMRCFI: 0.97RMSEA: 0.03Between SRMR: 0.10
Within SRMR: 0.05Slide19
Internal Consistency Reliability
All items at individual level had Cronbach’s alpha above 0.70Access to Care
α = 0.77Doctor Communication α = 0.89Courteous/Helpful Staff α = 0.85Slide20
Practice Site Reliability
Practice site reliability estimate were acceptable for all site with at least 4 cliniciansFor
a site with 1 clinicianOnly Access to Care had reliability above 0.70For a site with 2-3 cliniciansAccess to Care and Courteous/Helpful Staff had reliability above 0.70The average number of respondents for 1 clinician and 2-3 clinicians was less than 100
Smaller sites need more respondents per practice to increase reliability to acceptable levelsSlide21
Individual Correlations
Composites and
Global Ratings12341. Access to Care 2. Doctor Communication0.35
3. Courteous/Helpful
Staff0.290.254. Overall Doctor Rating0.390.520.225. Recommend Doctor’s Office0.340.520.29
0.47
All correlations were significant
(
p < 0.05)
Strongest correlation was between Doctor Communication and Overall Global Rating ItemsSlide22
Practice Site Level Correlations
All correlations were significant (p < 0.05)
Composites and Global Ratings1234
1. Access
to Care 2. Doctor Communication0.453. Courteous/Helpful Staff0.570.414. Overall Doctor Rating0.42
0.750.345. Recommend Doctor’s Office
0.52
0.76
0.43
0.76
Strongest correlation was between Doctor Communication and Recommend Doctor’s OfficeSlide23
Summary
Overall, both the individual level and multilevel confirmatory factor analysis results provided support for the survey’s three composites
The CG-CAHPS composites have acceptable individual-level internal consistency reliabilityThe reliability remains acceptable across sites with four to twenty or more clinicians Slide24
Email:
naomidyer@westat.com