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Transcript

Jeff Brady: The Agency for Healthcare Research and Quality welcomes you to our series of podcasts on topics related to CAHPS surveys. I'm Rear Admiral Jeff Brady, Assistant Surgeon General, U.S. Public Health Service and director of AHRQ’s Center for Quality Improvement and Patient Safety. We are pleased to sponsor this podcast series as part of our mission to develop and disseminate scientific knowledge, tools, and data to improve the health care system and help patients make informed health care decisions. I’d like to introduce Dale Shaller, who will moderate this podcast.

Dale Shaller [Moderator]:  Thank you Dr. Brady. I'm Dale Shaller, a member of the CAHPS research team based at Yale University and today I’m speaking with Caren Ginsberg, who is the director of AHRQ’s CAHPS program. She’ll talk about some of the benefits of using CAHPS surveys of patient experience. Caren, thanks for joining me today!

Caren Ginsberg: Thanks, Dale; I’m happy to be here. So as you know, AHRQ’s been developing CAHPS surveys for 20 years now, but not everyone is familiar with the surveys or why they should use them.

Dale Shaller: Yeah, that’s been my experience too. So let’s start with what I think is a really fundamental question. Why conduct a survey of patient experience?

Caren Ginsberg:  Well, the best way to find out if patients are getting high quality and patient-centered health care is to hear from the patients themselves about what happened and one of the most important ways to get this kind of feedback is from patient surveys.

Dale Shaller: Can you say a little more about that? What is the value of patient surveys for gathering that kind of information about a patient’s experience?

Caren Ginsberg: Surveys are important for patient feedback because they let providers see beyond one patient’s experience.   You know, it’s easy to dismiss what you hear from just one person, or even a few people. But when you are hearing the same thing again and again and again from a significant number of people, and -- this is important -- and those people are randomly sampled from your patient population, you can start to trust that you’re getting reliable information.

Dale Shaller:  Yeah, well Caren, I sometimes hear from health care providers that they’re already conducting some kind of survey and they don’t really know why they should make the change to a CAHPS survey. So how would you respond to that?

Caren Ginsberg:  One reason to use a CAHPS survey is that the surveys are scientifically sound. AHRQ is a research-focused agency and we’ve been developing and maintaining the CAHPS surveys for 20 years now. And our goal is to produce surveys that have value to health plans and providers and consumers and purchasers because the surveys give them useful and reliable information. We make sure the surveys are up-to-date and that the surveys are consistent with the best practices, and produce useful information.

And let me also say that CAHPS surveys are designed to capture information about the experience of care, rather than patient satisfaction. Almost all of the questions in CAHPS surveys ask whether or how often the things that are supposed to happen, like quick access to care and good communication with providers, actually did happen. And that’s very different from asking people about how satisfying something was or how they felt about their care. Even the few ratings questions that do appear in CAHPS surveys are asked in a way that prompts people to think about the specific aspects of their experience. And because of that emphasis on the patient’s experience, CAHPS surveys offer information that’s concrete and actionable.

Dale Shaller: That’s really very helpful, but I’m wondering if you can say just a little bit more about the science behind these CAHPS instruments?

Caren Ginsberg:   Well, CAHPS is very much steeped in the best evidence available on experience of care surveys and this applies to the content of the surveys, the methodology for developing the surveys and the measures, sampling strategies and data collection, and the analysis of survey data. And we invest a lot of time and effort in making sure that the survey questions, for example, reflect aspects of patient experience that are truly important to consumers and also valued by health care providers.

The CAHPS program takes very seriously our responsibility to produce surveys that are scientifically and statistically sound so that the results are valid and reliable. And that’s what makes the CAHPS surveys such a credible source of information on patient experience.

Dale Shaller: Okay, so how does the application of survey science benefit the users of CAHPS surveys?

Caren Ginsberg: So from the beginning—20 years ago—we made a commitment to produce surveys that are both standardized and flexible. Standardization means that you’ll get comparable information. The surveys all rely on a standardized set of core questions and standardized recommendations for sampling and data collection. So if everyone is asking the same questions of comparable populations in the same way, and then reporting the results in the same way, you can make valid comparisons. But if, you know, organizations were to pick and choose the parts of the survey that were more interesting to them or field it however they like, they would end up with information that’s not comparable—and therefore not nearly as useful.

Dale Shaller: But you also mentioned that the CAHPS surveys are flexible. And so how do you take standardization and flexibility and put them together?

Caren Ginsberg: Well, many providers already survey their patients and they want to continue tracking certain metrics that are important to them.  So, we design the CAHPS surveys to accommodate additional questions. And survey users are always free to incorporate questions from their previous surveys. Also, the CAHPS program offers supplemental questions and you can add these to a specific survey, let’s say if you want to ask about other experiences or drill down a little bit.

Dale Shaller: Caren, let’s say I represented a provider organization, what would you say to me would be the best reason for me to value standardization?

Caren Ginsberg: Well, as I mentioned, one of the most concrete benefits of CAHPS surveys is being able to compare your health care organization’s performance to other similar organizations. And to help you do this, we maintain a database which compiles survey results submitted by users and it generates comparative information. So organizations that use the trademarked CAHPS Health Plan and Clinician & Group Surveys are eligible to submit their data to the Database to see how they compare and to review the survey benchmarks.

Dale Shaller: Caren, thanks so much. This has been such a helpful discussion about the benefits of CAHPS surveys. Do you have any last thoughts that you’d like to share?

Caren Ginsberg: Yes, Dale, a couple of thoughts. And the first thing I’d like to say is that when you see the name CAHPS with the trademark symbol, you can be assured that the survey has been through a thorough and conscientious effort to produce a scientifically valid tool that results in useful and reliable data.

And finally, I want to point out that our emphasis on research means that the surveys go through a continuous process of refinement and testing. And we’re always listening to survey users and looking for ways to make the surveys even more useful. So if listeners have thoughts or ideas about the surveys that they’d like to share, my colleagues and I want to hear from you.

Dale Shaller: Great, thanks again, Caren.

Caren Ginsberg: Thank you, Dale.

Jeff Brady: Thank you for listening to this podcast from the Agency for Healthcare Research and Quality. You can download and listen to a variety of podcasts about CAHPS on our Web site at www.ahrq.gov/cahps. That’s www.a-h-r-q.gov slash [/] c-a-h-p-s [www.ahrq.gov/cahps]. The Agency also offers free technical assistance for CAHPS surveys at 1-800-492-9261 or by email at cahps1@westat.com. That’s CAHPS, the number 1, at [@] w-e-s-t-a-t.com [cahps1@westat.com].