the john d. stoeckle center for primary care innovation cahps driven quality improvement: primary...
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The John D. Stoeckle Centerfor Primary Care Innovation
CAHPS Driven Quality Improvement: Primary Care
Susan Edgman-Levitan,PAExecutive Director
Stoeckle Center for Primary Care Innovation Massachusetts General Hospital
Co-PI, Yale/Harvard CAHPS Team
The John D. Stoeckle Centerfor Primary Care Innovation
IFCC Core Concepts of Patient and Family-Centered Care
• Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.
• Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care
and decision-making.
The John D. Stoeckle Centerfor Primary Care Innovation
IFCC Core Concepts of Patient and Family-Centered Care
• Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
• Collaboration. Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation; in facility design; and in professional education, as well as in the delivery of care.
The John D. Stoeckle Centerfor Primary Care Innovation
Dimensions of Patient and Family-Centered Care
• In addition to safe and technically excellent care, patients and families identify the following specific dimensions as the most critical aspects of the ambulatory care experience: • Access;• Respect for patients’ values and preferences;• Coordination of care;• Information, communication, and education;• Emotional support;• Involvement of friends and family;
The John D. Stoeckle Centerfor Primary Care Innovation
Clinician-Group CAHPS and Patient and Family- Centered Care
• Getting Appointments and Health Care When Needed• Access to information and appointments• Waiting times in the office and exam room
• How Well Doctors Communicate• Respect for patient preferences• Clear and understandable information about
diagnosis, treatments, and medications• Listening and empathy
• Courteous and Helpful Office Staff• Respectful, helpful, and courteous office
staff• Overall Rating
The John D. Stoeckle Centerfor Primary Care Innovation
The CAHPS® Improvement Guide
• A resource manual for health plans and medical groups seeking to improve their CAHPS® scores
• Funded by CMS (Medicare) and developed by Harvard Medical School CAHPS® Team
• Over 2 dozen strategies mapped to CAHPS® core questions
The CAHPS® I mprovement GuidePractical Strategies for I mproving the Patient Care Experience
CAHPS®
The John D. Stoeckle Centerfor Primary Care Innovation
Plan Strategy- Create team (if needed)
- Establish/confirm goals
- Investigate potential interventions (see Section 4)
Develop and Test Strategy- Select measures to monitor progress- Develop changes using selected
intervention- Conduct small tests of change
- Adapt changes to organizational context
- Identify and deal with barriers Monitor Strategy
- Implement changes and hold the gains
- Evaluate progress against criteria
Reassess & Respond- Use CAHPS data to assess what worked, what didn’t
- Spread successful innovations
Section 4.Ideas for Improving Experiences with Care
Section 2. Identifying Opportunities to Improve
Getting needed
care
Getting care
quickly
Doctors communicate
well
Customer service
Home health & preventive
services
For each opportunity:
Section 1. Setting the Stage: An Infrastructure that Supports Improved
Performance
Section 3. Implementing the CAHPS Improvement Cycle
A Guide to the CAHPS QI Guidebook
Claims Processing
The John D. Stoeckle Centerfor Primary Care Innovation
CAHPS and Quality Improvement
• CAHPS III:• Refining QI model for implementing patient and
family-centered care• Creation of a meta-model to guide practice redesign
and implementation of patient and family-centered care;
• Updating of CAHPS Improvement Guide to link with new Health Plan and Clinician-Group CAHPS surveys
• Conversion to a web-based document to improve access and linkages to CAHPS reports.
The John D. Stoeckle Centerfor Primary Care Innovation
Factors That May Contribute to Measurable and Sustained Improvement
• Leadership is committed and engaged• Strategic goals are aimed at organizational
transformation • Focusing on involving patients and families in redesign
and improvement activities.• Focus on employee, clinician, and patient satisfaction.• Internal communication and action are aligned with
strategic goals• Motivation through external rewards and incentives
The John D. Stoeckle Centerfor Primary Care Innovation
Strategies for Clinician-Group CAHPS QI
• Link patient experience of care data to internal incentive programs
• Link patient experience of care data to external P4P programs
• data to P4P and other incentives• Collect and report physician-level data
The John D. Stoeckle Centerfor Primary Care Innovation
Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger.
Franklin P. Jones
The John D. Stoeckle Centerfor Primary Care Innovation
Strategies for Clinician-Group CAHPS QI
• Perform analyses that address “50 ways to deny the data”
• Staff surveys• Educational efforts at multiple levels of the
organization• Link to other performance data
• Panel size• Practice design• HEDIS data
The John D. Stoeckle Centerfor Primary Care Innovation
Responses By Length Of Pt-MD RelationshipCommunication Measure
40
50
60
70
80
90
100
Practices
Una
djus
ted
Scor
e
Yes (>3 yr)
No (<3 yr)
The John D. Stoeckle Centerfor Primary Care Innovation
Responses By Length Of Pt-MD RelationshipKnowledge Measure
40
50
60
70
80
90
100
Practices
Una
djus
ted
Sco
re
Yes (>3 yr)
No (<3 yr)