[Federal Register Volume 80, Number 13 (Wednesday, January 21, 2015)]
[Notices]
[Pages 2938-2939]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-00767]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Notice of Proposed Changes for the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS) Clinician & Group Survey

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of request for public comments.

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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) seeks 
comments on proposed changes to the CAHPS Clinician & Group (CG-CAHPS) 
Survey, including the Patient-Centered Medical Home (PCMH) Item Set. 
The CG-CAHPS survey is a product of the CAHPS program, which is funded 
and administered by AHRQ. AHRQ works closely with a consortium of 
public and private research organizations to develop and maintain 
surveys and tools to advance patient-centered care. AHRQ proposes these 
revisions in order to enhance the survey usability and functionality. 
AHRQ will implement these changes and release a new version of the CG-
CAHPS Survey, Version 3.0. in 2015.

DATES: AHRQ encourages submission of comments via email because postal 
mail addressed to AHRQ is subject to delay due to security screening. 
Please submit email comments to: [email protected] and write ``CAHPS 
Proposed Changes'' on the subject line.
    If filing comments on paper, write ``CAHPS Proposed Changes'' on 
the comments and on the envelope, and mail them to: Christine Crofton, 
Ph.D., AHRQ CAHPS Program Director, Center for Quality Improvement and 
Patient Safety, Agency for Healthcare Research and Quality, 540 Gaither 
Road, Rockville, MD 20850.
    Comments on this notice must be received no later than 5 p.m. EST 
on February 20, 2015. AHRQ will remove all commenter identifying 
information from the comments and will not provide individual 
responses. AHRQ will provide a summary of the comments and actions 
taken as a result of those comments. The summary document will be 
posted on the AHRQ CAHPS Web site https://cahps.ahrq.gov/index.html no 
later than 45 days after the closing of the comment period.

FOR FURTHER INFORMATION CONTACT: Christine Crofton, Ph.D., AHRQ CAHPS 
Program Director, Center for Quality Improvement and Patient Safety, 
Agency for Healthcare Research and Quality, 540 Gaither Road, 
Rockville, MD 20850, Email: [email protected], Phone: 
(301) 427-1323.

ADDRESSES: Information about the CAHPS Program--including background 
information, surveys, and tools--can be found on the AHRQ CAHPS Web 
site at https://cahps.ahrq.gov/index.html.

SUPPLEMENTARY INFORMATION: 

Background

    Through its CAHPS program, AHRQ has been advancing the research and 
practice of patient-centered care (CAHPS[supreg] is a registered 
trademark of the Agency for Healthcare Research and Quality). The goals 
of the CAHPS program are: (1) To develop standardized surveys that 
organizations can use to collect comparable information on patients' 
experiences with care, and (2) to generate tools and resources to 
support the dissemination and use of comparative survey results to 
inform the public about and improve health care quality. The 
CAHPS[supreg] surveys assess quality of care from the patient point of 
view in their use of health plans as well as various ambulatory and 
institutional settings, including physician practices, hospitals, and 
nursing homes. The surveys address a range of health care services and 
provide results that address the various needs of health care 
consumers, purchasers, health plans developers, providers, and 
policymakers.
    The CAHPS Consortium--which includes two AHRQ grantees (RAND 
Corporation and Yale School of Public Health), Westat (a support 
contractor), and AHRQ staff--are responsible for the research and 
development work necessary to produce CAHPS instruments, survey 
protocols, analysis tools, and reporting guidance. The consortium plays 
a critical role in educating and supporting organizations that use 
CAHPS products and data.
Proposed Changes
    AHRQ is proposing changes to the CG-CAHPS Core Survey, including 
the PCMH Item Set. These proposals are based on feedback from survey 
users and other stakeholders.
    The following principles have guided the changes to the survey and 
item set: (a) Minimizing the burden of surveys on patients and 
providers and to ensure consistency across multiple mandates for 
patient experience surveying by developing a single core survey; (b) 
balancing suggestions to shorten the survey with requests to add 
content--such as a measure of care coordination--while retaining the 
core topic areas of access, communication, office staff interactions, 
and a provider rating; and (c) maximizing the reliability of the CG-
CAHPS reporting measures by grounding all recommended changes in 
analyses of relevant data. The proposed changes aim to balance the 
importance of the measures to patients and stakeholders with the 
reliability and validity of the measures.
    Listed below is an overview of the proposed changes to the CG-CAHPS 
Survey, including the PCMH Item Set. Further details about the specific 
changes by composite measure and at the item level can be found on the 
AHRQ CAHPS Web site at: https://cahps.ahrq.gov/surveys-guidance/cg/about/proposed-cg-update.html.

Changes to CG-CAHPS Survey

    Survey reference time period: AHRQ proposes changing the reference 
time period of the CG-CAHPS Survey from ``In the last 12 months'' to 
``In the last six months.'' Rationale: This change will make the survey 
consistent with the survey versions being implemented by the Centers 
for Medicare & Medicaid Services (CMS), including the ACO CAHPS Survey 
and the CAHPS Survey for the Physician Quality Reporting System (PQRS). 
A study that randomized patients to a 12-month or 6-month survey 
version yielded similar CAHPS scores at the practice site level.
    Access composite measure: AHRQ proposes reducing the number of 
items in this composite measure from five items to three items: ``Got 
urgent care appointment'', ``Got appointment for checkup or routine 
care'', and ``Got answer to medical question the same day.'' Rationale: 
These items are important to patients and stakeholders, have good 
reliability, and include multiple aspects of access.
    Communication composite measure: AHRQ proposes reducing the number 
of items in this composite measure from six items to four items: 
``Explains things in a way that is easy to understand'', ``Listens 
carefully'', ``Shows respect for what you have to say'', and ``Spends 
enough time.'' Rationale: The proposed four-item composite is 
consistent with the communication measure in the CAHPS Health Plan 
Survey.
    Care Coordination composite measure: Care coordination is an 
important aspect of patient experience that is commonly assessed by 
CAHPS surveys. The goal was to develop a care coordination composite 
measure that could be standardized across CAHPS surveys. According to 
an article by Ron D. Hays et al, the CAHPS Medicare Survey includes a 
10-item measure, but a shorter measure may make standardization more 
likely. The full

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article published in 2013 in Medical Care Research and Review is 
available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959996/. 
Given the importance of care coordination for stakeholders and 
patients, AHRQ proposes to add a composite measure to the CG-CAHPS core 
survey. Since two of the items are already part of the core survey, 
this new composite requires the addition of only one item to the core 
survey.
    The new three-item care coordination composite would consist of 
``Follow up on test results'' (from the CG-CAHPS core survey), ``Knows 
important information about medical history'' (from the CG-CAHPS core 
survey), and ``Provider talked about all prescription medicines being 
taken'' (from the PCMH Item Set).
    With these changes, including the addition of the care coordination 
measure, the final core CG-CAHPS Survey will be reduced from 34 items 
to 31 items.

Patient-Centered Medical Home (PCMH) Item Set

    The PCMH Item Set is a collection of supplemental items that ask 
about experiences with the domains of a medical home. The combination 
of the core CG-CAHPS Survey with the PCMH Item Set constitutes the 
CAHPS PCMH Survey. The PCMH Survey has been used by the National 
Committee for Quality Assurance (NCQA) as part of its PCMH Recognition 
Program (see below, Related Efforts). AHRQ proposes the following 
changes to the PCMH Item Set.
    Shared decision making: AHRQ proposes moving three items to the 
general set of supplemental items. Rationale: The items require large 
sample sizes to achieve acceptable unit-level reliability.
    Self-management support: AHRQ proposes retaining two items. 
Rationale: While reliability estimates were mixed for different data 
sets, stakeholders have deemed these items critical to PCMH Item Set.
    Attention to mental or emotional health: AHRQ proposes retaining 
one item ``Things that cause worry or stress'' and moving the other two 
items--``Depression screening'' and ``Personal or family problems''--to 
the general set of supplemental items. Rationale: AHRQ agrees with 
NCQA's view that three items are not necessary to capture 
comprehensiveness. The retained item is most correlated with the 
overall composite.
    Information on getting care on evenings, weekends, and holidays: 
AHRQ proposes retaining this item, which is also regarded by NCQA's 
stakeholders as critical for inclusion for PCMH Item Set.
    Getting care on evenings, weekends, and holidays: AHRQ proposes 
moving this item to the general set of supplemental items. Rationale: 
The number of responses in most practice-based surveys is insufficient 
to achieve reliability.
    Days wait for urgent care: AHRQ proposes moving this item to the 
general set of supplemental items. Rationale: AHRQ supports NCQA's 
proposal regarding this item.
    Reminders between visits: AHRQ proposes moving this item to the 
general set of supplemental items. Rationale: AHRQ supports NCQA's 
proposal regarding this item.
    Care coordination items: The PCMH Item Set includes two items 
related to care coordination. These items did not combine to form a 
composite measure. As noted above, AHRQ proposes moving the item 
``Provider talked about all the prescription medicines being taken'' 
into the core survey for the new measure of care coordination. AHRQ 
also proposes changing the current, ``Yes-No response'', scale for this 
item to a, ``Never/Sometimes/Usually/Always'' frequency response, 
scale. The second item, ``Provider informed and up-to-date on care from 
specialists'' would remain in the PCMH Item Set.

Related Efforts

    AHRQ has been working closely with the CMS, our Federal partner in 
the CAHPS Consortium, throughout this process to achieve alignment with 
the CAHPS Survey for ACOs and the CAHPS for PQRS Survey. For specific 
questions about these surveys, contact the ACO CAHPS team at 
[email protected] or 1-855-472-4746 or the PQRS CAHPS team at 
[email protected].
    As noted, NCQA currently uses the CAHPS PCMH Survey as part of its 
PCMH Recognition Program. NCQA has issued a separate proposal for 
changes to the survey that may be used for the PCMH program in the 
future. For specific questions about the use of the PCMH Survey by 
NCQA, contact their customer support at (888) 275-7585 or 
[email protected].

    Dated: January 13, 2015.
Richard Kronick,
AHRQ Director.
[FR Doc. 2015-00767 Filed 1-20-15; 8:45 am]
BILLING CODE 4160-90-M