206760 Thinking CAHPS: Strategies to get more actionable information from surveys of health care service quality

Wednesday, November 11, 2009: 11:10 AM

S. Rae Starr, M Phil, MOB , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Eleanor Young, RHIA, MPH , L.A. Care Health Plan, Los Angeles, CA
The CAHPS health plan survey is used nationally by public agencies, private payers, and consumers to assess the quality of health care services. Health plans use CAHPS to identify areas for improvement. This presentation reports statistical and methodological lessons learned in using the CAHPS survey within a large Medicaid health plan covering diverse, low-income populations in Los Angeles County, California. It examines strategies by which biostatisticians can increase the information bandwidth that CAHPS provides to departments that directly touch members and providers: (1) Breadth: Adding supplemental questions to gather feedback about interventions; tying CAHPS findings to HEDIS by exploring barriers to access and problems with patient adherence. (2) Depth: Adding data fields in sampling frame files--(demographics, geographic groupings, health conditions, utilization, member call-ins and checkups)--to aid in causal analysis and intervention design. (3) Power: Pooling respondents over time and across samples to increase effective sample size, which permits more sensitive analysis of member subpopulations, toward feedback at the medical group level. (4) Effective reporting: Triaging CAHPS findings to specific programs, using existing tools for rapid reporting: correlation matrices; banner tables; segmentation analysis. (5) Avoiding pitfalls in survey contracting and oversight: Improving response rates; validation of samples and completes; weighting to adjust for bias; access to anonymous data. (6) Seeking voice for survey purchasers and end-users: Transparency of sampling and interviewing methods; scoring vendor performance; building common tools; portability of data across vendors; pooling data on providers. Refining these strategies can make member surveys more informative and actionable.

Learning Objectives:
1. Describe and apply two methods for increasing the information obtained through CAHPS surveys. 2. Assess two options for increasing statistical power in CAHPS analyses. 3. Identify and avoid pitfalls in survey contracting, monitoring, and reporting. 4. Design survey reports for greater actionability within programs and departments. 5. Identify and apply methods for increasing voice and collaboration among CAHPS survey purchasers and end-users.

Keywords: Member Surveys, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Education: Master of Philosophy in Policy Analysis from the RAND Graduate School of Policy Analysis (Santa Monica CA); Master of Organizational Behavior from Brigham Young University (Provo, UT); Bachelor of Political Science with Honors from Brigham Young University (Provo UT). Experience: Five years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2009, including all facets of the survey to be discussed in the presentation. L.A. Care Health Plan is the largest public health insurer in the United States, and its CAHPS survey in a typical year represents approximately 800,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. The challenges here likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
L.A. Care Health Plan CAHPS member satisfaction survey Employment (includes retainer) and [The presentation is about CAHPS surveys, not my employer. The presentation will include examples from L.A. Care's CAHPS survey. I can include or omit L.A. Care's name to comply with your guidelines.]

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.