[Federal Register Volume 69, Number 112 (Thursday, June 10, 2004)]
[Notices]
[Pages 32559-32560]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-13104]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Request for Measures of Patients' Ambulatory Care Experiences

AGENCY: Agency for Healthcare Research and quality (AHRQ), DHHS.

ACTION: Notice of request for measures.

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SUMMARY: The Agency for Healthcare Research and quality (AHRQ) is 
soliciting the submission of instruments or items that measure 
patients' perceptions of the quality of ambulatory care from 
researchers, health plans and other health care providers, 
stakeholders, vendors and other interested parties. This initiative is 
in response to input from stakeholders to revise the CAHPS[reg] tool in 
order to measure different categories of ambulatory health care to 
provide useful information to multiple audiences, and to provide 
performance data that are more actionable for quality improvement than 
the previous CAHPS[reg] instrument.
    AHRQ is initiating the redesign of the CAHPS[reg] health plan 
instrument to include different levels of ambulatory health care 
delivery, i.e., services provided by individual primary care clinicians 
(such as a physicians or nurse practitioners); sites of care (that is a 
particular geographic location or facility from which care is 
delivered); group practices (where two or more practitioners legally 
organize as a medical group to deliver care under certain conditions); 
and health plans (the payor of health care services in either fee-for-
service or managed care arrangements); through a review of existing 
instruments that capture the patients' ambulatory care experiences and 
perceptions at these different levels. There are several functional 
areas of ambulatory care that existing instruments (or items) speak to 
at specific delivery levels, but presently, not every level of 
ambulatory care delivery is addressed. Functional areas include: 
Access; communication; courtesy and respect; shared decision making; 
coordination integration of care; health promotion and education; 
customer service and decision-support. Our response to stakeholder 
input will ultimately provide users with a flexible, modular approach 
to be known as Ambulatory CAHPS (ACAHPS), to assess the quality of 
ambulatory care for all the functions listed above at the different 
delivery levels of the ambulatory care system. Presently, we are 
interested in receiving instruments and/or survey items that have been 
used for ambulatory care at the health plan level and that address any 
of the above-listed aspects of ambulatory care.
    At a later time, we plan to ask for items that address a broader 
array of functions and topics at different delivery levels. However, at 
this time, please submit only those items directly relevant to the 
topics or functions specified below in the section on Submission 
Criteria.

DATES: Please submit instruments or items and supporting information on 
or before July 12, 2004. AHRQ will not respond individually to 
submitters, but will consider all submitted instruments and items and 
publicly report the results of the review of the submissions in 
aggregate.

ADDRESSES: Submissions should include a brief cover letter, a copy of 
an instrument or items for consideration and supporting statements and 
information as specified under the Submission Criteria below. 
Submissions may be in the form of a letter or e-mail, preferably as an 
electronic file with an E-mail attachment. Electronic submissions are 
strongly encouraged. Responses to this request should be submitted to: 
Charles Darby, Agency for Healthcare Research and quality, 540 Gaither 
Road, Rockville, MD 20850, Phone: (301) 427-1324, Fax: (301) 427-1341, 
E-mail: [email protected].
    To facilitate handling of submissions, please include full 
information about the instrument developer or contact: (a) Name, (b) 
title, (c) organization, (d) mailing address, (e) telephone number, (f) 
fax number, and (g) e-mail address. Also, please submit with a copy of 
the instrument or items for consideration, evidence that it/they 
meet(s) the criteria set out under the Submission Criteria section 
below. It is requested that citation of peer-reviewed journal 
article(s) pertaining to the instrument or item(s) include the title of 
the article, author(s), publication year, journal name, volume, issue, 
and page numbers where article appears, may be included but are not 
required. Please do not use acronyms in your submissions.
    Submitters must also provide a statement of willingness to grant to 
AHRQ the right to use and authorize others to use submitted measures 
and their documentation as part of a new or revised CAHPS[reg]-
trademarked instrument. The new CAHPS[reg] instrument for patient 
assessment of ambulatory care will, as in the past, be made publicly 
available, free of charge.

FOR FURTHER INFORMATION CONTACT: Charles Darby, Center for Quality

[[Page 32560]]

Improvement and Patient Safety, Agency for Healthcare Research and 
Quality, 540 Gaither Road, Rockville, MD 20850; Phone: (301) 427-1324; 
Fax: (301) 427-1341; E-mail: [email protected].

Submission Criteria

    Instruments submitted should focus on ambulatory care at the health 
plan level and for these functions:
     Coordination of care between providers or sites of care 
for patients with chronic conditions;
     Shared decision-making or patient involvement in decision-
making about health care options and treatment;
     Availability of information from the health plan to 
promote consumer decision-making about health care options and 
treatment;
     Providing care that is culturally appropriate or that 
tries to meet the cultural and linguistic needs of patients;
     Availability and usability of plan-level information on 
benefits, coverage and out-of-pocket cost to consumers for ambulatory 
medical services as well as pharmacy services;
     Availability and usability of consumer information from 
the health plan that compares individual ambulatory care providers;
     Availability and usability of consumer information from 
the health plan to assist consumers in the selection of an individual 
clinician (primary care or specialist); and,
     Effectiveness of health plan call center staff and 
customer service staff.
    Measures submitted must meet these criteria to be considered: 
Capture the patients' experience of ambulatory care; demonstrate a high 
degree of reliability and validity; and have been used widely, not just 
in one or two research studies. Submitter's willingness to grant to 
AHRQ the right to use and authorize others to use the instrument means 
that the CAHPS[reg] trademark will be applied to a new instrument 
combining the best features of all the submissions as well as any ideas 
that may develop from reviewing them. Accordingly, to encourage 
universal use, free access to any final Ambulatory CAHPS instrument(s), 
and free access to the instrument's supportive/administrative 
information as done in the past, is planned. Thus, submitters of items 
that may be incorporated in the new ACAHPS documents will be required 
to permit such universal free access to their incorporated item(s). 
However, item ownership will be protected during testing of the new 
ambulatory care surveys. AHRQ, in collaboration with expert CAHPS 
grantees, will evaluate all submitted instruments or items and select 
one or more either in whole or in part for testing and, if required, 
modification. AHRQ will assume responsibility for the final instruments 
as well as any future modifications.
    The final instruments will bear the CAHPS[reg] trademark and they 
will be made freely available for use by all interested parties. 
Submitters will relinquish exclusive control of any items that appear 
in the final instrument. As a matter of quality control, there will be 
warnings that the CAHPS[reg] identification may not be used if any 
changes are made to the instrument or final measure set without review 
and permission of the Agency.
    Each submission should include the following information:
     The name of the instrument;
     Whether the instrument/item(s) is disease or condition 
specific;
     Domain(s) of the instrument/items;
     Language(s) the instrument/item(s) is available in;
     Evidence of cultural/cross group comparability, if any;
     Instrument reliability (internal consistency, test-retest, 
etc.);
     Validity (content, construct, criterion-related);
     Response rates;
     Methods and results of cognitive testing and field-
testing;
     Description of sampling strategies and data collection 
protocols, including such elements as mode of administration, use of 
advance letters, timing and frequencies of contacts;
     A list of where the instrument has been fielded and at 
what level it has been and/or is being used; and,
     Evidence addressing the criteria should be demonstrated 
through submission of peer-reviewed journal article(s) or through the 
best evidence available at the time of submission.
    Submission of copies and existing report formats developed to 
disclose findings to consumers and providers is desirable, but not 
required. Additionally, information about existing database(s) for the 
instrument(s) submitted is helpful, but also not required for 
submission.

SUPPLEMENTARY INFORMATION:

Background

    Since 1995, the only ambulatory CAHPS[reg] survey has been focused 
on health plan level, though there are different versions across types 
of plans from fee-for-service through HMOs, as well as optional 
modules. Significant stakeholder interest has emerged in using a 
standard CAHPS[reg] survey beyond the health plan level specifically 
for group practices and clinician-level surveys.
    The idea behind ACAHPS is to provide a flexible, modular approach 
to assessing the quality of ambulatory care at different levels of the 
health care system while still retaining the valuable aspects of the 
current CAHPS[reg] Health Plan Survey such as industry standardization 
and comparability.
    Although many combinations of ACAHPS modules are possible, the 
CAHPS Consortium plans to simplify the task of constructing a survey by 
developing several sets of pre-packaged survey instruments and data 
collection protocols. These surveys will be designed to address the 
most common applications based on the market research completed in 2003 
as well as the on-going input from stakeholders. We will also provide 
guidelines for reporting the results of these surveys to external and 
internal audiences.
    In addition, we will design some simple decision trees to help 
users assess their needs and recommend a prepackaged survey or help 
users to build their own using the ACAHPS modules. Technical assistance 
will continue to be offered from the CAHPS-SUN Helpline, 1-800-492-9261 
and the Web site located at http://www.cahps-sun.org.

    Dated: June 3, 2004.
Carolyn M. Clancy,
Director.
[FR Doc. 04-13104 Filed 6-9-04; 8:45 am]
BILLING CODE 4160-90-M