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Engage, Collect, Partner:
How to Use Patient
Experience of Care Surveys
in Your Practice
May 22, 2014
We Want To Hear From You!
Type questions into the
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2
Patient-Centered Primary Care Institute
History and Development
• Launched in 2012
• Public-private partnership
• Broad array of technical
assistance for practices at all
stages of transformation
– Learning Collaboratives
– Website (www.pcpci.org)
– Webinars & Online Learning
• Ongoing mechanism to support
practice transformation and
quality improvement in Oregon
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PCPCH Model of Care
Oregon’s PCPCH Model is defined by six core attributes, each with specific
standards and measures
• Access to Care
– “Be there when we need you”
• Accountability
– “Take responsibility for us to receive the best possible health care”
• Comprehensive Whole Person Care
– “Provide/help us get the health care and information we need”
• Continuity
– “Be our partner over time in caring for us”
• Coordination and Integration
– “Help us navigate the system to get the care we need safely and timely
manner”
• Person and Family Centered Care
– “Recognize we are the most important part of the care team, and we our
responsible for our overall health and wellness”
Read more: http://primarycarehome.oregon.gov
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Engage, Collect, Partner:
How to Use Patient Experience of Care
Surveys in Your Practice
Colleen Reuland, MS - Oregon Pediatric Improvement Partnership
Jon Yost, MD – Bay Clinic Pediatrics
Lisa Kranz – Family Medical Group Northeast
Colleen Reuland, MS
Director, Oregon Pediatric Improvement Partnership
Instructor, Department of Pediatrics, OHSU
reulandc@ohsu.edu www.oregon-pip.org
Learning Objectives
 Understand how the CAHPS CG PCMH provides unique
and complementary information to guide medical home
improvement efforts
 Obtain practical methods a practice can use to
meaningfully implement the CAHPS CG PCMH in a way
that engages patients, providers and office staff
 Learn from primary care practices who have implemented
these methods, and the successes and key learnings
gathered
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PCPCH Standards that Relate to Patient
Experience of Care Surveys
Standard 1.A – In-Person Access
o 1.A.1 - PCPCH surveys a sample of its population on satisfaction with in-person access to care. (5
points)
o 1.A.2 - PCPCH surveys a sample of its population using one of the Consumer Assessment of
Healthcare Providers and Systems (CAHPS) survey tools on patient satisfaction with access to care.
(10 points)
o 1.A.3 - PCPCH surveys a sample of its population using one of the CAHPS survey tools, and meets a
benchmark on patient satisfaction with access to care. (15 points)
Standard 6.C – Experience of Care
o
o
o
6.C.1 - PCPCH surveys a sample of its patients and families at least annually on their experience of
care. The patient survey must include questions on access to care, provider or health team
communication, coordination of care, and staff helpfulness. The recommended patient experience of
care survey is one of the CAHPS survey tools. (5 points)
6.C.2 - PCPCH surveys a sample of its population at least annually on their experience of care using
one of the CAHPS survey tools. The patient survey must at least include questions on provider
communication, coordination of care, and practice staff helpfulness. (10 points)
6.C.3 - PCPCH surveys a sample of its population at least annually on their experience of care using
one of the CAHPS survey tools and meets benchmarks on the majority of the domains regarding
provider communication, coordination of care, and practice staff helpfulness. (15 points)
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FEDERAL CMS:
CHIPRA CORE MEASURE
SET
CAHPS, CAHPS Everywhere!
Oregon Examples: Using Data to Improve Care?
CAHPSHealth
Plan
(HP)
CAHPS- HP
with the
Children
Chronic
Conditions
(CCC)
National CAHPS;
CMS Adult and Child
Quality Grants; State
Sponsored; CCO
Incentive Metric;
Several CCOs also
collecting through
CPCI; Other Efforts
CAHPS Clinician
and Group (CG)
CAHPS CGPatientCentered
Medical Home
CAHPS CG
PCMH
Emphasized in
Oregon Medical
Home Standards,
Unstandardized
Data Collection,
Practices collecting
data and doing
nothing more
Supported by
CHIPRA
Demonstration
Grant for
Practices, QCORP Effort,
CMMI Grant
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What Does CAHPS CG PCMH Mean?
• This stands for:
– Consumer Assessment of Healthcare Providers and
Systems (CAHPS- this is the name of the survey)
– Clinician and Group (CG- this is a specific version of the
survey for practices)
– Patient Centered Medical Home (PCMH- this is a version
of the CG survey with items added to measure aspects of
medical homes)
• Survey is provided to a sample of patients who have
had a visit in the 12 months
– Two versions available:
• Child Version
• Adult Version
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CAHPS CG PCMH:
Why is this Version Useful for PCPCH
What does the tool address?
Adult Survey
• Access
• Communication
• Self-Management Support
• Office Staff
• Shared Decision Making
• Adult Behavior
Child Survey
 Access
 Communication
 Self-Management Support
 Office Staff
 Child Development
 Child Prevention
Who gets the survey?
A sample of patients who had a visit in the last year
Sample is comprised of all patients – not just publicly insured
Why is valuable for patient-centered medical homes to use?
In general, maps to the components of medical home
Provides more information about the content of care
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CAHPS CG PCMH Administration:
Approaches Used by Practices
• In order to be valid, recommended to that a
standardized vendor administration is used.
• ADDED to the survey screeners to identify patients
with special health care needs (SHCN)
• Spotlight of two OPIP supported practices using
different approaches:
• Bay Clinic – Administered by their office
– Wasn’t feasible for them to use a survey vendor
– Therefore, assisted them in implementing themselves in a way that tried
to minimize (not able to eliminate) biases of in-office administration
• Family Medical Group Northeast – Administered by a Survey
Vendor
– Survey administrated by a survey vendor through participation in TriState Children’s Health Consortium (TCHIC)
– Oregon Health Authority supported
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OPIP Support to Practices in
Using the CAHPS CG PCMH
Two arms of support to support meaningful use by the
practice:
1) Methods to use BEFORE and DURING survey
administration
2) Methods to use AFTER you get the survey data – how to
USE and make it meaningful information
• You will see that the methods describe intentionally
address the Standards 2.C ( Patient and Family
Involvement in QI) and Standard 2.D – Quality
Improvement
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Tools to Enhance Practice and
Patient Engagement on CAHPS CG PCMH
BEFORE Survey Administration
1. Elevator Speech to Engage the Rest of the Practice: Overview
materials on the CAHPS CG PCMH to explain the survey to your
office generally
2. Posters to put up in the office and share publicly to give
patients a heads up
• This poster could also be distributed through website or
Facebook.
Materials to give to staff before the survey to answer questions
they may receive
3.
Scripts for office staff to use (This could be used now)
4. Text for email from providers to patients
5. Frequently asked question you may get and their answers
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Elevator Speech Slides to Engage
the PRACTICE on the CAHPS CG PCMH
• Editable short slide show
that you can use to inform
staff of your efforts around
CAHPS
– What is CAHPS CG PCMH?
– Why are we doing this?
– Topics addressed in the
survey
– Things staff might see or
use in the practice as part
of this effort
– What to expect in the
coming months
15
Materials to Engage Patients
in the CAHPS CG PCMH
Poster to Educate Patients
about Survey
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CAHPS Resources OverviewPOSTERS
• Posters for before and during
administration
– Undergone readability assessments
and cognitive testing
• Two versions, one for parents, one
for patients (different picture and
slightly different language)
• Customized with practice name
• For placement in waiting and exam
rooms
• Addresses concerns from previous
administration
– Provides expected timeline for
potential respondents
– Lets potential respondents know IT
IS ACTUALLY FOR THE PRACTICE
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CAHPS Resources Overview- Scripts
• Talking points to inform
parents and patients of the
survey and its importance
– Sets for the Provider, and
MA/RN/other staff
• Expresses the importance of
feedback to the provider
– Clarifies the use of
information for
IMPROVEMENT
• Informs parent/patient of
relationship to survey vendor
• Reiterates and emphasizes
confidentiality
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CAHPS Resources Overview- FAQ
• For use by office staff to answer
questions frequently asked by
patients:
– Who is sponsoring the survey
– Purpose of survey
– Questions about who should fill it
out
– Getting surveys in different
languages
– How did I get chosen?
– Concerns about coming from a
survey vendor and location
– Repeat surveys
– How to address certain scenarios
(lost/ruined surveys, what ifs etc.)
– Defining terms (PCMH, NCQA, etc)
– General questions about the survey
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OPIP Support of Practices
Doing the Survey Themselves
• Coaching and assistance on timing of the survey to reduce
(not eliminate) biases of an in-office administration
o Survey administration over a couple of months
o Options for mail-based survey
• Built the survey items into Survey Monkey for the practice
staff to ENTER the survey data
o Survey monkey provided item-level responses
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OPIP Support to Practices in Using
the CAHPS CG PCMH
AFTER the Survey is Collected
1. Analysis of the data into “bite size” pieces
o
o
o
Roll up of the item-level data into composite measures that give
a “Flag” about what it means
Analyzing the data by groups of patients
Distilling the data into strengths and opportunities for
improvement
2. Methods to meaningful engage the practice in examining
the data and what is MEANS
3. Methods for reporting the findings back to patients and
to engage patients as partners in QI
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Example of Survey Data Being Rolled
up into “Flags”
Example of OPIP CAHPS CG PCMH Analysis: Range of CAHPS CG PCMH
Child Quality Domain Achievement Scores across ECHO Practices
H
H
100%
H
90%
L
Achievement Score
80%
70%
60%
H
L
50%
H
40%
L
L
30%
20%
L
10%
0%
L
H
Access
83.37%
Communication
96.73%
Child Development
60.35%
Child Prevention
55.82%
Self-Management
29.33%
Office Staff
93.60%
H = Highest practice score
L = Lowest practice score
Analysis and Facilitation by the Oregon Pediatric Improvement Partnership (OPIP )
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Item-Level Drivers
Within Domain Scores
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Comparison of NCQA PCMH and
CAHPS CG PCMH Related to Access
CAHPS CG PCMH
After Hours Access
NCQA PCMH Element 1B
After-Hours Access
Q19. Usually or always able to get care needed from
provider's office during evenings, weekends, or holidays
T-CHIC
T-CHIC
Oregon
Oregon
Childhood Health
Practice
#1
Associates
of Salem
Childhood Health
Practice #1
Associates of Salem
The Children's
PracticeClinic
#2
The Children's Clinic
Practice #2
Portland Pediatric Clinic
↑
↑
Practice #3
The Children's Clinic
Practice #3
Tualatin Pediatric Clinic
↑
Family Medical
Group#4
NE
Practice
Practice
#4NE
Family Medical
Group
HillsboroPractice
Pediatric #5
Clinic
St. Luke's Eastern Oregon
Practice #6
Medical Associates
Hillsboro Pediatric
PracticeClinic
#5
↓
St. Luke's Eastern Oregon
Practice #6
Medical Associates
↓
WindingPractice
Waters Clinic
#7
Winding
Waters #7
Clinic
Practice
↑
Woodburn Pediatric
Practice
#8
Clinic
Woodburn Pediatric
Practice
#8
Clinic
0%
0%
Worse
20%
40%
60%
80%
100%
Worse
Score
Better
↑↓Statistically significantly higher/lower than State score.
20%
40%
60%
Score
80%
100%
Better
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Selected “AHA” Moments for Practices
Based on CAHPS CG PCMH Data
• Systems and processes don’t always yield the intended
consequences
o Access domain findings surprising to a number of practices
despite having “open access”
 Led to improvements in how hours are communicated to
patients
 Led to examinations of how patients access the practice
(e.g. phone lines) and how it would be more patient
centered
o Important differences for distinct groups of kids that get lost in
“overall” findings
 Many practices doing well overall, but found significant
disparities in quality domains by child and respondent
characteristics
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Examples of Characteristics by which Variations
in the CAHPS CG PCMH Data Quality
Domains were Accessed
Characteristics of
Persons Care Being
Reported About in
Survey
Children & Youth with
Special Health Care Needs
(CYSCHN)
Child CAHPS CG PCMH Only
Respondent
Characteristics
Ethnicity
CYSHCN
Age of
Respondent
Race
Number of consequences
Education
Age of Patient
Type of Consequences
Language survey
completed
General Health Status
Mental Health Status
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Variations in ECHO Sites Child CAHPS CG PCMH
Findings by Child’s Ethnicity and/or Race
Analysis and Facilitation by the Oregon Pediatric Improvement Partnership (OPIP )
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CAHPS CG PCMH Findings:
Example of Analysis by CYSHCN Screener
T-CHIC Added to the Survey
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CAHPS CG PCMH Findings:
Example of Analysis by CYSHCN Screener
T-CHIC Added to the Survey
29
Variations in CAHPS CG PCMH Findings
by Age of Child
CAHPS CG PCMH Quality Domain Achievement Scores For
Which There Were Significant Differences by Age of Child
Achievement Score
100%
80%
60%
40%
20%
0%
Child Development
0 up to 5 years
Child Prevention
5 years up to 12 years
Self-Management
12 years and up
Analysis and Facilitation by the Oregon Pediatric Improvement Partnership (OPIP )
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Leveraging the CAHPS CG PCMH to Enhance
Patient Engaging in Quality Improvement:
Reporting the Findings Back to Parents- Why Consider it?
• Patient experience of care data is something patients can understand
o Of the quality data that you collect, patients understand survey data
o That said, they fill out a lot of surveys and are very unclear how this information is
being used
o Particularly in Oregon where various versions of the CAHPS are being used,
important for patients to know what you are doing with it.
• If you report the survey findings back to patients, you start to change the culture in a
practice
o Visible display to patients that you want to hear them and will use their feedback
o Helps to create a culture of transparency around the data
o Possible way to find your improvement partner
o In ideal world, this would have been done closer to when the survey was
administered
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• May increase response rate to the next survey
o In personal experiences, observed practices that have done this have obtained
higher response rates the next time
o Before the next round of the CAHPS CG PCMH, can use a similar type of poster to
give parents a heads up about the survey coming and why are asking for their
input
31
Example from Woodburn Pediatrics
32
Jon Yost, MD
Pediatrician, Bay Clinic Pediatrics
Clinic Spotlight: Bay Clinic Pediatrics
• Patient experience of care
– CAHPS CG PCMH (with CYSHN Screener)
– Used in-office administration and convenience sample of
patients who came in for a visit
– Fielded for Two Months (July-September)
• Methods
– Part of department strategy, clinic-wide/cultural commitment
• Healthy competition between providers
– Promotion (front desk, waiting rooms, exam rooms)
– Administration
• Web-based or paper versions (depending on patient preference)
disseminated by PROVIDERS at all visits for a pre-determined interval
(2 months)
• In addition, surveys were sent by mail to a subpopulation- CYSHN
based on provider gestalt and one subpopulation -ADHD
34
OPIP Support of Bay Clinic Pediatrics
• Patient-centered administration
– Mapped out process for administering in the office
– Created survey administration materials
•
•
•
•
Posters for the parent
Scripts for office staff
Letters
Survey monkey version
• QI Coaching
– Process for who how data will be reviewed
– Process for how improvement opportunities
– Levers to use with CCO
• Analysis and reporting
– Feedback reports of data
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Planning Your Administration:
Outline the Steps and Assign Roles
36
37
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We got the survey data….now what?
• Summary reports provided by OPIP
– Overall quality of care findings by the domains
in the survey
• Item-level drivers – potential areas of improvement
– Findings by important group
• By provider
• Children and youth with special health care needs
39
Example of OPIP CAHPS CG PCMH Analysis: Range of
CAHPS CG PCMH Quality Domain Achievement Scores
across Bay Clinic Providers
H
H
H
H
H
L
H
L
L
L
L
L
H = Highest provider score
L = Lowest provider score
40
Example of OPIP CAHPS CG PCMH Analysis:
Variation in CAHPS CG PCMH Self-Management Domain
Achievement Scores by Bay Clinic Provider
Self-Management Domain Item
Q49. Someone at provider’s office talked to you about
specific goals for your child’s health
Q50. Someone at provider’s office asked you if there are
things that make it hard for you to take care of your
child’s health
Provider
Average Achievement
Score
Provider #1
57%
Provider #2
68%
Provider #3
33%
Provider #4
39%
Provider #1
34%
Provider #2
35%
Provider #3
4%
Provider #4
22%
Blue text is used to indicate a statistically significant difference between each provider’s average achievement score.
Green-shaded cells indicate the highest score where there is a statistically significant difference in quality.
Analysis and Facilitation by the Oregon Pediatric Improvement Partnership (OPIP )
41
Improvement Opportunities Identified
• Communication: Child Development, Office
hours, Imaging results
• Changed work-flow to allow more chart review
prior to going into exam room, more deliberate
referral tracking
• CCO recently hired care manager for our clinic
42
Family Medical Group – NE
Lisa Kranz
Family Medical Group Northeast’s
Use CAHPS CG PCMH
•
Part of the Enhancing Child Health in Oregon Learning
Collaborative
o http://www.oregon-pip.org/projects/echo.html
o FALL 2012:
 Through this effort, Oregon Health Authority supported a central
contract with DataStat for the CAHPS CG PCMH administration
 Submitted a child and adult survey sample
 Support from OHA partners in pressuring ALL Scripts in
order to create the sample file pull
o FALL 2014:
 Administering the survey again
 Allows us to understand the impact of our medical home quality
improvement activities on the patient experience of care
44
We did the survey…now what?
• Summary report provided by DataStat
– Overall quality of care findings
– Item-level findings
• ECHO Learning Calls
– How to interpret data
– Issues to consider
• Summary reports provided by OPIP
– “Cliff Notes” summary of the report
• Item-level drivers – potential areas of improvement
• The Punchline
– Findings by important groups
• By child and respondent characteristics
– Children and youth with special health care needs
– Age of the child
– Race-ethnicity
45
Strengths and Improvement
Opportunities Identified
• Areas where we were doing well
– Access – care when needed
– Communication
– Office staff
• Areas where we needed improvement
–
–
–
–
Access – care evenings, weekends, holidays
Self management
Child development
Adult Behavioral Health
46
Reporting CAHPS Findings Back to
PATIENTS
After the First Round
47
Reporting CAHPS Finding
Back to PATIENTS
Domains from
CAHPS –
We would have
a moveable
arrow to
identify
current QI
focus
Here we are
describing
the CAHPS
and QI that
is going on
in our
practice
Information
about how to
get involved
in our PFAC
or provide ad
hoc
suggestions
Here we
would Insert
specific
things that
the practice
is trialing, use
data and ask
for feedback
and ideas
How to get involved in our Patient and Family Advisory Group
48
QI Efforts Implemented Based
on CAHPS
• Efforts focused on ACCESS to care
– Overall composite score = 83.7%; drill down, indicated only
50% of patients were able to obtain afterhours care.
– Needed more information on the “why” of not meeting the
afterhours needs
– Sent out a survey monkey to our patients (we heard you,
now tell us more) – still not understanding the problem
– Took info to our Patient-Family advisors – The “Aha!”
moment- (None knew how to contact us afterhours)
– Next step: Updated our brochure, website and scripting
for staff following-up on patients seen in ER & ED
49
Implementing CAHPS Again!
• Two years later able to use the CAHPS again
– Allows us to examine the impact of our QI
efforts on the patient experience of care
• With support from OPIP, enhancing practice and
patient engagement BEFORE survey
administration
50
Patient Engagement for CAHPS
Round Two
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Opportunity for Practices to Get Support to
Implement the Approaches Presented Today
• http://www.pcpci.org/2014-learning-collaboratives
• Improving Patient Experience of Care collaborative
includes:
– CAHPS CG PCMH using a survey vendor (at no cost to the
site)
– Practice coaching and support to meaningful engage
providers and patients in using the survey.
• Deadline to submit an application is Friday,
May 30, 2014,
• Questions: reulandc@ohsu.edu
52
What Questions Do You Have?
Type questions into the
Questions Pane at any time
during this presentation
53
Resources & Thanks!
• http://www.oregon-pip.org
• http://www.pcpci.org/2014-learningcollaboratives
• Thanks!
• Please complete post-webinar survey
54