269703 Fielding a patient satisfaction survey in a community health clinic

Monday, October 29, 2012 : 9:10 AM - 9:30 AM

Marian Ryan, PhD, MPH, CHES , Research and Development, Institute for Healthcare Advancement, La Habra, CA
Objective To pilot test the newly developed CAHPS-modified patient survey with an English-speaking population receiving services from a state-licensed community health clinic. This survey will be a component of NCQA recognition as a patient-centered medical home (PCMH).

Background The PCMH item set was designed and added to core questions from the CAHPS Clinician & Group Survey to assess the additional domains of patient experience and care expected in a PCMH. The additional questions inquire about whole-person care, shared decision-making, and screening for additional needs such as nutrition education or help with substance use problem.

Methods This retrospective study examines patient experiences for selected patients and parents of pediatric patients via service encounter information from our EMR system, dates ranging from July 1, 2010 through June 30, 2011. Inclusion criteria included at least two provider visits during this period and a reported language preference of English. The patient population was stratified by provider, and respective adult and pediatric samples were selected as those meeting majority provider algorithm rules. As many as 10 attempts were made to reach selected sample patients unless closed for inaccurate mailing address and inaccurate phone numbers.

Results - Our final patient sample was the following: 144 adult and 367 pediatric patients totaling 511 surveys. Adult response rates were 36.1% and the pediatric 22.2%. The active refusal rates were 13.2% and 10.8% respectively; unable to contact rates were 13.3% and 15.0%. Consistent with other studies on patient survey responses, patients rated satisfaction with identified provider higher than scores assigned for specific behaviors associated with patient-centered care. The highest domain scores were reported for provider communication and the lowest domain scores were reported for self-management support and shared decision-making. Bivariate analyzes were conducted; however, few significant associations were found. Two key associations were the following: patients 35 years of age and older reported significantly more support with self-management than younger patients, and persons with lower education levels reported receiving lower levels of comprehensive care.

Conclusions Results were shared with the pilot research team (Harvard/AHRQ/RAND). There were many challenges conducting this pilot within a community health center environment that must be considered with future application of the survey. Despite these challenges, we had above average response rates for the English survey and have been selected to pilot-test the Spanish survey.

Learning Areas:
Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
1.Recognize the challenges of fielding a patient survey in a community health clinic environment. 2.Identify potential options to improve response rate in this setting. 3.Identify factors associated with higher levels of reported patient-centered care.

Keywords: Primary Care, Patient Satisfaction

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: After a successful 20 year career in healthcare as a provider and administrator, I completed the doctoral program at Brandeis University, MA February 2010. As a predoctoral AHRQ fellow and a senior research associate for the Schneider Institutes for Health Policy I served as co-principal investigator on several federally funded research projects. My quantitative dissertation examined longitudinally the impact of care coordination on quality health outcomes among seniors with multi-morbidity using multilevel modeling techniques.
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.