1.

Confirming and Supplementing CAHPS® Communication Items

Using Feedback fromHigh-Performing Physicians.

Ron D. Hays, Ph.D.,Professor of Medicine and Health

Services, UCLA.

Denise D. Quigley, Ph.D.,CAHPS Quality Improvement Team,

RAND.

AHRQ Conference.

September 11, 2012 (8-9:30am session)(

2.

Presentation Outline.

• Why focus on doctor-patient communication?

• Do CAHPS surveys capture important elements of doctor-patient communication from physician perspective?

• Feedback from high-performing physicians

• Summary and implications

3.

Presentation Outline.

• Why focus on doctor-patient communication?

• Do CAHPS surveys capture important elements of doctor-patient communication from physician perspective?

• Feedback from high-performing physicians

• Summary and implications

4.

Doctor-Patient Communication Is Critically Important to Patients.

• Good communication skills are among the qualities most desired • Doctor listens to patient concerns,• Doctor explains health problems clearly,.

• Effective communication is key to positive patient-doctor relationships.

• Patient reports about communication are strongly associated with global ratings .

5.

Communication Measures used to Improve Patient Experience.

• Quality improvement.

• Element of pay-for-performance systems

• Recognition as a patient-centered medical home.

6.

Presentation Outline.

• Why focus on doctor-patient communication?

• Do CAHPS surveys capture important elements of doctor-patient communication from physician perspective?

• Feedback from high-performing physicians

• Summary and implications

7.

CAHPS Surveys Address Communication from Patient Perspective.

• During CAHPS development, consumers identify important aspects of care.

• Patients are the best or only source of information for most measures.

• Clinician and Group (CG) CAHPS topics include.• doctor-patient communication.• access.• coordination of care.• courtesy and helpfulness of office staff.• overall rating of doctor.

8.

Physicians Have InvaluablePerspective on Communication Items.

• As CAHPS stakeholders, physicians are consulted during CAHPS survey development.

• But physicians are not interviewed about best practices related to communication.

9.

We Asked High-Performing Physicians… ,

How well do the CAHPS survey items capture

the important elements of

doctor-patient communication?

10.

Existing Collaboration with Health Plan Facilitated Exploratory Study.

Health plan.

• Has 72,000 adult, commercial HMO members.

• Administers CAHPS clinician-group survey annually (2005-2012).

• Uses CAHPS for P4P, Q.I., and reporting.

• Was interested in physician perspective.

• Gave us physician-level CAHPS data and contact information.

• Permitted us to contact their physicians.

11.

High-Performing Physicians on CAHPS were Identified

• 2008 CAHPS data. • 20,141 patients among 259 primary care

physicians (46% response rate).

• Calculated overall z-score (0-100 score). • Average of CAHPS composites (access,

communication, office staff) and global rating of physician.

• Rank ordered the 259 doctors by z-score.

12.

Physician Interviews.

• Contacted the 40 highest-ranked doctors; interviewed 11 physicians who were willing.

• Used a semi-structured, open-ended protocol with 36 questions.• Basic information about practice. • Philosophy of providing good care.• Communication behaviors during patient

visits.• Office practices related to communication.

• Taped and transcribed interviews.

13.

Themes Coded… ,

• Coded the content of the interviews for important themes.

• Created unique counts of codes per physicians; found 16 themes.

• Two researchers independently coded the presence or absence of each of the 16 themes.• Calculated a pooled kappa to assess

inter-rater agreement for 16 themes (0.72).

14.

… and Compared Themes to Behaviors Captured in CAHPS Survey Items.

• Core CAHPS items.• Doctor-patient communication.

• Supplemental CAHPS items.• Health information and promotion. • Shared decision-making. • Patient-centered medical home items. • Cultural competence. • Health literacy. • Health information technology.

15.

Presentation Outline.

• Why focus on doctor-patient communication?

• Do CAHPS surveys capture important elements of doctor-patient communication from physician perspective?

• Feedback from high-performing physicians

• Summary and implications

16.

Physicians Identified 16 Behaviors that Support Communication.

• 9 mentioned by more than 7 of 11 physicians.

• 6 of 9 most frequently mentioned behaviors captured in current CAHPS items.

• 3 behaviors identified for further survey item development.

17.

Nine Behaviors Mentioned Frequently (n = 11 physicians).(n =

11 1. Employ office staff with good people skills (91%)

2. Use non-verbal communication (82%)

3. Involve office staff in communication with patients (82%)

4. Spend enough time with patients; don’t act hurried (73%)

5. Listen carefully (73%)

6. Provide clear, simple explanations (64%)

7. Greet patients by shaking hands, introducing self (64%)

8. Ask social or personal questions; track and follow this information (64%)

9. Devise action plans/next steps at each visit (64%)

18.

CAHPS Captures Six of theNine Behaviors.

1. Employ office staff with good people skills

2. Use non-verbal communication

3. Involve office staff in communication with patients

4. Spend enough time with patients; don’t act hurried

5. Listen carefully

6. Provide clear, simple explanations

7. Greet patients by shaking hands, introducing self

8. Ask social or personal questions; track and follow this information

9. Devise action plans/next steps at each visit

19.

Presentation Outline.

• Why focus on doctor-patient communication?

• Do CAHPS surveys capture important elements of doctor-patient communication from physician perspective?

• Feedback from high-performing physicians

• Summary and implications.

20.

Summary of Findings.

• CAHPS survey items capture many of the communication behaviors most frequently mentioned by high performing physicians.

• Three aspects of communication are not captured by current CAHPS items.• Non-verbal communication.• Greeting the patient.• Tracking personal information about the

patient.

21.

Possible Next Steps

• Testing and developing additional patient experience-of-care measures• Nonverbal communication• Physician greeting and introducing self to

patient and family• Physician tracking of personal information

about patient

• Further research is important to understand additional value and association with other patient experience measures

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