247834 Patient-guided quality improvement: Linking CAHPS to HEDIS and other measures of health system performance

Sunday, October 30, 2011

S. Rae Starr, MPhil, MOrgBehav , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
CAHPS is the most widely used standardized instrument for measuring member satisfaction and comparing performance among health plans in the United States. This briefing reviews the art of extracting specific quality improvement guidance from CAHPS, drawn from the palette of options available for the questionnaire, the survey protocol, and for reports tailored to guide program design.

(1) Connecting service quality to clinical quality: In prioritizing quality improvement activities, patient satisfaction is often given less attention than clinical quality of care. The briefing will discuss evidence that patient satisfaction and clinical quality are two sides of the same coin, because patient behavior (responding to high or low quality of services) mediates the effectiveness of many clinical treatments.

(2) Setting: The presentation will cover lessons learned from 1999 to 2011 at a large urban Medicaid health plan in the southwestern United States, serving a diverse population.

(3) Bridging to other metrics on quality: Adding questions to CAHPS helps provide tie-ins to HEDIS, to other required studies about access and other measures on the quality of services and care. When designed with synergy in mind, these studies can be used to independently test, confirm, and strengthen each other.

(4) Using causal analyses to guide and evolve programs: The functional departments in health systems have contracts, audits, and other sources of influence and feedback on the services that patients receive in the clinic. Appended variables are particularly important for post hoc analysis of the impact of projects on patient satisfaction and patient compliance.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Explain the linkage between service quality (measured on CAHPS) and clinical quality of care (measured on HEDIS). 2. Explain how to use CAHPS findings to guide the design of quality improvement projects. 3. Describe methods for effective survey contracting, for more meaningful surveys and CAHPS reports that engage and inform key process owners. 4. Discuss the impact of patient satisfaction on retention and other measures of system performance and quality. 5. Discuss complementary uses of HP CAHPS and newer instruments in the CAHPS family of surveys.

Keywords: Quality Improvement, Patient Satisfaction

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Experience: Six years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2011, including all facets of the survey to be discussed in the presentation. Designed supplemental questions to make CAHPS relevant to other measures of organizational performance, such as HEDIS, Access To Care studies, to obtain actionable information to guide the design of interventions to improve the quality of services and care. Added questions to identify the linkage between patient satisfaction with service quality and with avoidance of care. Used member feedback to identify gaps in CAHPS, to provide feedback to each functional department in the health plan that deals directly with patients or with providers. Setting: L.A. Care Health Plan is a public entity serving Los Angeles County, California, and the largest public health insurer in the United States. L.A. Care's CAHPS survey represents voice for approximately 850,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. The challenges addressed at L.A. Care likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly. 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).
Any relevant financial relationships? No

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.