ps consumer assessment health plan survey: cahps® gathering patient experiences oktober 2004...
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Consumer Assessment Health Plan Survey: CAHPS®
Gathering patient experiences
Oktober 2004Barbara Vriens
Outline
• Instruments
• Construction
• Response
• Validation
• Key findings Hospitals and Diabetics
• Questions
Instruments (1): 2 Markets
Medical outcome Medical outcome
Quality of life Quality of life
Patiënt experience Patiënt experience
Innovative technologie Innovative technologie
HealthProvider
Health plan Customers
Instruments (2): CAHPS
• Consumer Assessment of Health Plans Survey, developed by the Agency for Healthcare Research and Quality (AHRQ) in the U.S.
• A CAHPS-questionnaire captures the experiences of patients with received care and experiences of customers with a health plan.
Instruments (3): developed june 2003 – june 2004
• Healthcare market
• Diabetics CAHPS-NL
• Hospital CAHPS-NL
• Health insurance market
• Commercial CAHPS-NL
Instruments (4): Items (experience, not satisfaction)
• Getting needed care• Getting care quickly• Courteous, respectful and helpful office staff • How well doctors & nurses communicate• Health plans customer service, information and
paperwork• Global ratings (nurses, doctors, hospital, health plan)• Patient/Consumer demographics• Quality of care (diabetic, i.e. group- cahps)
Construction (1): proces
CAHPS®:Adult Commercial QuestionnaireAdult MedicAid Managed CareAdult MedicAid Fee-for-ServiceSupplement Hospital CAHPS®
Selection of
questions
Translation US-Dutch
And Dutch-US
Choice of best
translation
Translate
and add extra
questions
Construction (2): proces
Extra questions were added in the following CAHPS:
• Commercial CAHPS-NL: questions about language spoken in order to see differences in non-Dutch origin and Dutch origin;
• Diabetics CAHPS-NL: QUOTE*-questions about specific diabetic-care (formulated in CAHPS structure).
* QUality Of care Through the patients’ Eyes. The Quote-Diabetes is developed by Nivel, 2000.
ResponseNumber of addresses
Crude response
Commercial CAHPS-NL
977 56%
Diabetic CAHPS-NL(Amsterdam)
983 57%
Hospital CAHPS-NL(2 hospitals)
1.996 66%
Validation: Key findings Commercial CAHPS-NL• Compares health insurance companies on
• Getting needed care• Getting care quickly• Courteous, respectful and helpful office staff • How well doctors & nurses communicate• Health plans customer service, information and paperwork• Global ratings (nurses, doctors, hospital, health plan)• Patient/Consumer demographics
• The translated questionnaire is found to be a useful instrument in the context of the Dutch healthcare system;
• A few questions should be adjusted to improve the questionnaire;
• Overall the new instrument was found to be valid and reliable.
Validation: Key findings Hospital CAHPS-NL• Seven factors relating to patient hospital experience were constructed:
• communication with doctor• communication with nurses• discharge information• communication about medication• pain control• physical environment• nursing services
• Communication with nurses had the strongest relationship with the global ratings for nurses and hospital and likelihood of recommending the hospital;
• Differences between the two hospitals can be pointed out as differences between quality
• Overall the new instrument was found to be valid and reliable;• The findings mirrored the results in the US and surveys in Dutch hospitals.
Experience hospital A and B (ill and healthy)
Hoe vaak goede uitleg door ...
1,0
1,5
2,0
2,5
3,0
3,5
4,0
v06-verpleegkundige v13-arts
Ziek Totaal Gezond
Experience (hospital A and B)
Hoe vaak goede uitleg door ...
1,0
1,5
2,0
2,5
3,0
3,5
4,0
v06-verpleegkundige v13-arts
Zkh A Totaal Zkh B
Population (hospital A and B)
Verhouding zieke / gezonde respondenten, per ziekenhuis
0%
10%
20%
30%
40%
50%
60%
Zkh A Totaal Zkh B
Gezond Ziek
New Medication and discharge experiences• Both hospitals have low outcome on new medication
• Purpose and name of the medicine• Co-medication• Side-effects• Allergic reactions
• Both hospitals have low outcome on discharge information• Information how to behave• Information about taking notice
Validation: Key findings Diabetes CAHPS-NL
• For a few aspects the findings mirrored other studies. There
are limited studies available to compare;
• Ratings of patients have a relationship with the period in witch
care was received (check of HbA1c, Cholesterol, blood
pressure, feet);
• A few questions should be adjusted;
• Overall the new instrument was found to be a valid and reliable
basis for further development.
Score losse vragen en composiet Communicatie,incl. betrouwbaarheidsinterval 95%
0%
25%
50%
75%
100%
vraag1 vraag2 vraag3 vraag4 composiet
Huisarts Internist Verpleegkundige Diëtist
Show respect Listening carefully Explain things Have enough time Total
Composiet scores Afstemming, Begeleiding, Communicatie en Voorkomendheid,
incl. betrouwbaarheidsinterval 95%
0%
25%
50%
75%
100%
Huisarts Internist Verpleegkundige Diëtist
Afstemming Begeleiding Communicatie Voorkomendheid
HbA1c CAHPS Diabcare
Lower dan 9 79% 87%
9 or higher 21% 13%
Blood pressure CAHPS Diabcare
Lower dan 90 74% 80%
90 or higher 26% 20%
Lower dan 140 47% 45%
140 or higher 53% 55%
Outcome
CAHPS Diabcare
Eye controle 70% 68%
Feet controle 60% 65%
Urine controle 60% 82%
Blood pressure 90% 92%
HbA1c 87% 87%
Process
parameter proces Uitkomsten Punten
HbA1c(Long term suger)
93% of the patients had their HbA1c measured in the last 12 months
55% < 8%≤ 21% ≥ 9,5%
510
Lipid profile 85% of the patients had their lipid profile measured in the last 12 months
63% heeft LDL ≤ 130
mg/dl
20
Risc profile Of 90% of the patients the risk profile is known based on blood pressure, Hba1c and lipid profile
Improvement of 10%
40
parameter proces uitkomst bonus
Patient experience 90% is informed about HbA1c, blood pressure and life style
80% knows their own level of HbA1c, blood pressure and reproduces life style advise
20
afstemming(interaction between professionals)
80% gets uniform information from the different health providers of goals to achieve
20
Questions?
Patiëntenervaringen Ziekenhuis
• Formule en deskundigheid in huis of toegankelijk voor Agis• Database eigendom van Agis
• Tevredenheid communicatie• Tevredenheid zorg• Tevredenheid specialistische zorg• Tevredenheid toegang
Patiëntenervaringen diabeteszorg
• Formule en deskundigheid in huis of toegankelijk voor Agis• Database eigendom van Agis
• Diabeteszorg algemeen 58% goed of hoger• Diabetesvragen beantwoord 56%• Toegang acute vraag 46%• Uitleg labresultaten 50%• Respect zorgverlener 70%
• internist, diabetesverpleegkundige, diëtist,huisarts