NHPCO Guidelines for Using CAHPS Hospice Survey Results

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1 Intrductin NHPCO Guidelines fr Using CAHPS Hspice Survey Results The Centers fr Medicare and Medicaid Services (CMS) has develped the Cnsumer Assessment f Healthcare Prviders and Systems (CAHPS ) Hspice Survey t measure and assess the experiences f patients wh died while receiving hspice care, as well as the experiences f their infrmal primary caregivers. Starting in 2015, CMS requires hspices t participate in the new CAHPS Hspice Survey. As part f the prcess, and t ensure that survey data are unbiased, hspices are required t cntract with a third-party vendr that has been apprved by CMS and has gne thrugh CMS training in cllecting and submitting CAHPS survey data. In September f 2014 CMS released a list f vendrs that meet the CAHPS Hspice Survey requirements and that are cnditinally apprved t administer the CAHPS Hspice Survey. The list can be accessed n the CMS CAHPS Hspice Survey website. Perfrmance measures used t evaluate the quality f hspice care shuld be accurate measures f gd care that are directly influenced by hw the hspice perates, and that als take int accunt the unique needs and values f the patients and families served by hspice. Evaluating the results f hspice care frm the perspective f the family caregiver has been shwn t be a valuable means f demnstrating effectiveness f care delivery, and subsequently, an indicatin f quality hspice care. In additin t its utility fr accuntability, the CAHPS Hspice Survey shuld be used by hspices as a surce f meaningful and actinable data, and thereby a valid vehicle fr imprving utcmes and ensuring quality f care. 1

2 Hw t Use CAHPS Hspice Survey Results CMS has nt yet released the scring methdlgy fr the measures derived frm the CAHPS Hspice Survey r annunced final plans fr public reprting f the results. In the interim, NHPCO recmmends that yu fcus n the use f the CAHPS Hspice Survey as a means fr quality imprvement t infrm striving fr excellence by prviding the highest pssible quality f care. Until CMS prvides mre infrmatin n scring fr the CAHPS Hspice Survey we suggest that yu d the fllwing: 1. Becme familiar with all f the questins n the CAHPS Hspice Survey and the specific aspects f care represented by each ne. 2. Examine the respnse frequencies hw many times is each pssible respnse given fr each questin? What percentage f ttal respnses fr each questin des each respnse represent? 3. Lk fr pprtunities fr imprvement by examining the percentage f respnses t each questin that is nt the best pssible respnse. Fr example: Fr a CAHPS Hspice Survey questin that has a respnse set f Always Smetimes, Usually, and Never, the percentage f respnses ther than Always shws the magnitude f pprtunity fr imprvement. 4. Determine which pprtunities fr imprvement shuld be yur fcus based n yur hspice s standard f care. Fr example: If 3 in 10 persns respnded with the less than best respnse fr a questin, is that the gal that yu want t set fr yur hspice prgram? 5. Cmpare the characteristics f the respndents t the CAHPS Hspice Survey t the characteristics f the entire patient ppulatin served by yur hspice. CAHPS Hspice Survey results must be reviewed in cntext with ther factrs, such as patient and caregiver demgraphics, t determine if the results are representative f yur entire patient/family census. 2

3 AREAS FOR CAUTION 1. Be patient and judicius in interpreting CAHPS Hspice Survey results. Be wary f early returns. Results frm a small number f surveys may nt prvide a reliable representatin f yur hspice s perfrmance. Wait t examine results within a timeframe (e.g., calendar quarters) that will allw meaningful evaluatin f trends in scres. 2. Direct cmparisns with results fr questins frm the Family Evaluatin f Hspice Care (FEHC) survey are nt pssible. Because the scring fr the CAHPS Hspice Survey is nt yet available, there is n established relatinship between scres n the FEHC survey and questins n the CAHPS Hspice Survey -- even fr questins that have similar wrding. Therefre, it is impssible t predict hw a hspice will perfrm n the CAHPS Hspice Survey based n perfrmance n the FEHC survey. 3. CMS will eventually release natinal data fr the CAHPS Hspice Survey that can be used t cmpare hspices t each ther. Until that time, n natinal benchmarks are available. In the meantime, yu will have t rely n yur vendr fr cmparisn results and cautin is advised in interpreting cmparisns when yu are relying n the results frm a single vendr. If yur vendr prvides yu with cmparisn data yu shuld cnsider hw the hspices in the vendr s client base cmpare t yurs based n the answers t the fllwing: a. Hw many hspices are in the vendr s database? b. What are the rganizatinal characteristics (size, tax status, gegraphic area served, etc.) f thse hspices? 4. The methdlgy fr calculatin f the scres fr the quality measures derived frm the CAHPS Hspice Survey questins is nt yet available. CMS has designated multiple tpics (dmains) based n CAHPS Hspice Survey questins: Hspice team cmmunicatin (Q6, Q8, Q9, Q14, Q35) Getting timely care (Q5, Q7) Treating family member with respect (Q11, Q12) Prviding emtinal supprt (Q37, Q38) Supprt fr religius and spiritual beliefs (Q36) Getting help fr symptms (Q16, Q22, Q25, Q27) Infrmatin cntinuity (Q10) 3

4 Understanding the side effects f pain medicatin (Q18) Teach Hw t Care fr the Patient at Hme (Q19, Q20, Q23, Q29) Six are cmpsites (i.e., a cmbinatin f tw r mre questins) and three are single item indicatrs. Because the fficial calculatin methd is nt available, cmputatin f tpic/dmain scres shuld nt be attempted. Hwever, analysis f the data frm the CAHPS Hspice Survey field test demnstrated that the questins that cmprise each tpic are related. Hspices shuld grup these questins tgether when examining CAHPS Hspice Survey results and evaluating the need fr quality imprvement. 4

5 CAHPS HOSPICE SURVEY REPORT COMPONENTS The table belw presents NHPCO recmmendatins fr inclusin f data in CAHPS Hspice Survey results reprting that are needed t infrm and enhance hspices quality imprvement effrts. COMPONENT SHOULD HAVE NICE TO HAVE Respnse Frequencies Ttal number f respnses t each questin Number f respnses fr every respnse ptin fr each questin Percentages f respnses fr every respnse ptin fr each questin Graphic representatin f respnses s perfrmance can be seen at a glance Results brken ut by team (fr larger rganizatins) Results ver time Respndent Demgraphic Infrmatin Characteristics f caregivers wh cmpleted a survey: Age Gender Educatin level Relatinship t patient Ethnicity Race Characteristics f caregivers wh did nt cmplete a survey Patient Demgraphic Infrmatin Characteristics f the patients whse caregivers cmpleted a survey: Age Gender Ethnicity Race Principal diagnsis Lcatin f care Characteristics f patients whse caregivers did nt cmplete a survey Other Respnse rate 5

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