2013 ICH CAHPS Patient Experience Survey Results

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1 COMPANY LOGO 2013 ICH CAHPS Patient Experience Survey Results Research & Marketing Strategies 15 E. Genesee Street, Suite 210 Baldwinsville, NY Tel: Aggregate Survey Results

2 Table of Contents Section Page Background and Methodology 1 Summary Statistics 2 Kidney Doctors 4 Dialysis Center Staff 6 The Dialysis Center 12 Treatment 14 Additional Comments 17 Patient Demographics 19

3 Background and Methodology Research & Marketing Strategies conducts the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (CAHPS ) survey on behalf of numerous facilities to meet CMS requirements for patient experience surveying. This survey is designed to assess patients' experience of care received from (1) the kidney doctors; (2) the dialysis center staff; (3) the dialysis center; and (4) the overall treatment for their kidney disease. This was the second year that RMS has conducted the survey on behalf of in-center hemodialysis facilities. Eligibility requirements for the survey were (1) that the patient be age 18 years or older and (2) that the patient had been receiving dialysis at the center for at least 3 months. Each dialysis center provided RMS with the list of eligible patients for participation in the survey. RMS reviewed the patient information provided to verify that eligibility requirements were met for the patient population. You are receiving this report so that you can compare your individual facility's report with the aggregate RMS client results. This is a value-added report provided to you at no additional charge. We trust that you will find this information valuable as you look to monitor your quality and patient satisfaction metrics. PROCESS: RMS utilized one of two methodologies to conduct the survey; mixed mode or phone only mode. The Mixed Mode of survey administration includes an introductory letter, two mailings of the survey, a postcard reminder and telephone follow-up. The Phone Only Mode includes an introductory letter and up to 10 attempts to contact each patient by telephone. Surveys were offered and conducted in both English and Spanish languages. This report represents the aggregate results of the survey conducted on behalf of all the dialysis centers who contracted with RMS. The survey fieldwork represented in this report was conducted from May 2013 thru December The aggregate results can be used by the dialysis center to benchmark its own survey results for quality improvement purposes during the upcoming year. Comparisons to the aggregate survey results from 2012 are provided to show trends in the responses from the past year. Patients Sampled Completed Surveys 2013 Response Rate 2012 Response Rate English 4,674 2,439 52% Spanish Total 1, % 5,675 2,896 51% 49% 2012 to 2013 Survey Trend Increase Page 1

4 Summary Statistics and Overall Satisfaction Individual results from questions in each of the composite categories of service measured were combined into a single "top box" result for the entire service category. "Top box" results indicate the percentage of respondents reporting the most positive response(s) for each question (e.g. Always, Yes, and 9 or 10 on the 0 to 10 scale). Composite/Service Category 2013 Results 2012 Results (7 questions) (20 questions) (3 questions) (8 questions) Kidney Doctors 62% 66% Dialysis Center Staff 68% 70% The Dialysis Center 59% 61% Treatment 63% 65% (3 questions) Overall Satisfaction (Combined) 61% 64% 2012 to 2013 Survey Trend Decrease Decrease Decrease Decrease Decrease The aggregate summary indicates that overall satisfaction of patients has decreased across all service categories between 2012 to Facilities need to continually look for ways to meet and exceed patient expectations. Reasons for this change should be explored further. However it is important to note that being the second year of surveying, respondents are more familiar with the process and may have increased expectations based upon prior year responses. Using any number from 0 to 10, where 0 is the worst possible and 10 is the best possible, what number would you use to rate the...? Mean (Avg) Rating N = 9 to 10 6 to 8 2 to Kidney Doctors 2,774 58% 28% 11% 0 to 1 3% Dialysis Staff 2,740 30% 26% 9% 1% Dialysis Center 2,704 66% 7% 1% % 90% 80% 70% 40% 30% 0% 62% 58% 63% 66% 67% Kidney Doctors Dialysis Staff Dialysis Center (Prior year's results shown in faded colors) Page 2

5 Summary Statistics and Overall Satisfaction Making an Impact on the Patient Experience RMS performed correlation analysis on all of the survey questions regarding kidney doctors, dialysis center staff and the dialysis center to determine what most influences the respondents' overall rating of the dialysis center. The following 11 questions were all shown to have an impact on the respondents' rating of the dialysis center. The correlation number shown indicates how much of an impact the question had on the rating of the dialysis center. Any correlation greater than.5 indicates that there is some impact, and the closer the number gets to 1, the more impact on the overall rating. Staff "always" show for what you had to say ( Correlation = 0.57) 63% 59% Staff "always" check you as closely as you wanted ( Correlation = 0.56) Staff "always" behave in "Always" feel that staff really cared about you ( Correlation = 0.60) 63% Always 0.6 Other 0.4 rated dialysis staff the "best dialysis staff possible" (Correlation = 0.82) 67% Staff "always" make you as comfortable as possible ( Correlation = 0.58) 61% Staff "always" carefully to you ( Correlation = 0.57) 58% rated doctors the "best doctors possible" (Correlation = 0.51) Staff "always" spend enough time with you ( Correlation = 0.56) 55% Staff "always" explain things in a way that is easy to understand ( Correlation = 0.54) 58% a professional manner ( Correlation = 0.52) 71% the dialysis center is "always" as clean as it could be (Correlation = 0.55) Page 3

6 Kidney Doctors Questions on Survey Listen Carefully How often did your kidney doctors listen carefully to you? Explain Things How often did your kidney doctors explain things in a way that was easy to understand? Show Respect How often did your kidney doctors show respect for what you had to say? Spend Enough Time How often did your kidney doctors spend enough time with you? Care about You How often did you feel your kidney doctors really cared about you as a person? Informed and Up-to-date Do your kidney doctors seem informed and up to date about the health care you receive from other doctors? Page 4

7 Kidney Doctors Listen Carefully Explain Things Show Respect Spend Enough Time Care About You Informed and Up-to-date 100% 90% 84% 86% 80% 70% 64% 56% 59% 68% 72% 45% 63% 67% 40% 30% 0% (Prior year's results shown in faded colors) Graphed N= Listen Carefully 2,804 Explain Things 2,803 Show Respect 2,797 Spend Enough Time Care About You Always 64% 56% 59% 68% 72% 45% 63% 67% Yes 2,806 2,798 Informed and Up-to-date 2,695 84% Usually 21% 16% 26% 17% No 16% Sometimes 15% 14% 21% 13% Never 5% 9% 5% 9% 7% Correlation analysis of the survey results identifies "how often did you feel your kidney doctors really cared about you as a person" as having the greatest impact on the overall satisfaction rating of the kidney doctors. The personal relationship the doctors establish with the patients impacts the overall impression of the doctors. The remaining questions on this page also had strong impact on the patients' satisfaction with their doctors. Page 5

8 Dialysis Center Staff Questions on Survey Listen Carefully How often did the dialysis center staff listen carefully to you? Explain Things How often did the dialysis center staff explain things in a way that was easy to understand? Show Respect How often did the dialysis center staff show respect for what you had to say? Spend Enough Time How often did the dialysis center staff spend enough time with you? Care about You How often did you feel the dialysis center staff really cared about you as a person? Make You As Comfortable As Possible How often did dialysis center staff make you as comfortable as possible during dialysis? Keep Information Private Did dialysis center staff keep information about you and your health as private as possible from other patients? Feel Comfortable Asking for What You Wanted Did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care? Ask How Your Disease Affects Your Life Has anyone on the dialysis center staff asked you about how your kidney disease affects other parts of your life? How to Take Care of Your Graft, Fistula, or Catheter Do you know how to take care of your graft, fistula, or catheter? Page 6

9 Dialysis Center Staff Insert Needles with Little Pain How often did dialysis center staff insert your needles with as little pain as possible? Check You While on Dialysis Machine How often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine? Able to Manage Problems How often were the dialysis center staff able to manage problems during your dialysis? Behave in a Professional Manner How often did dialysis center staff behave in a professional manner? Talk About What You Should Eat and Drink Did dialysis center staff talk to you about what you should eat and drink? Explain Blood Tests How often did dialysis center staff explain blood test results in a way that was easy to understand? Give You Written Information about Your Rights Did this dialysis center ever give you any written information about your rights as a patient? Review Your Rights with You Did dialysis center staff at this center ever review your rights as a patient with you? Told You What to Do if Health Problem at Home Have dialysis center staff ever told you what to do if you experience a health problem at home? Told You How to Get Off the Machine in an Emergency Have any dialysis center staff ever told you how to get off the machine if there is an emergency at the center? Page 7

10 Listen Carefully Explain Things Dialysis Center Staff Show Respect Spend Enough Time Care About You Make You as Comfortable as Possible 100% 90% 80% 70% 61% 63% 58% 61% 63% 66% 55% 58% 63% 66% 67% 71% 40% 30% 0% (Prior year's results shown in faded colors) Graphed N= Listen Carefully Explain Things Show Respect 2,828 2,816 2,812 Spend Enough Time Always 61% 63% 58% 61% 63% 66% 55% 58% 63% 66% 2,801 Care About You 2,797 Make You as Comfortable as Possible 2,799 67% Usually 23% 23% 21% 26% 19% Sometimes 14% 15% 13% 15% 14% 12% Never 2% 5% 3% 4% 3% 2% Correlation analysis of the survey results identifies "how often did you feel the dialysis center staff really cared about you as a person" as having the greatest impact on the overall satisfaction rating of the dialysis center staff. The personal relationship the staff establishes with the patients impacts the patients' overall impression of the staff. All of the remaining questions on this page also had strong impact on the patients' satisfaction with the dialysis center staff. Page 8

11 Dialysis Center Staff Keep Information Private Feel Comfortable Asking for What You Wanted Ask How Your Disease Affects Your Life How to Take Care of Your Graft, Fistula, or Catheter Insert Needles with Little Pain 100% 90% 80% 70% 40% 30% 0% Graphed (Prior year's results shown in faded colors) N= 92% 93% Keep Information Private 90% 91% Feel Comfortable Asking for What You Wanted 54% 55% Ask How Your Disease Affects Your Life How to Take Care of Your Graft, Fistula, or Catheter 2,718 2,783 2,750 2,753 86% 87% 41% 40% Insert Needles with Little Pain Yes 92% 93% 90% 91% 54% 55% 86% 87% Always 41% 40% 2,131 No 8% 46% 14% Usually 33% Sometimes 21% Never 5% I insert my own needles 1% Page 9

12 Check You While on Dialysis Machine Dialysis Center Staff Able to Manage Problems Behave in a Professional Manner Talk About What You Should Eat and Drink Explain Blood Tests 100% 90% 91% 91% 80% 70% 59% 61% 56% 68% 72% 61% 63% 40% 30% 0% (Prior year's results shown in faded colors) Graphed N= Check You While on Dialysis Machine Able to Manage Problems Behave in a Professional Manner 2,747 1,269 2,781 Talk About What You Should Eat and Drink Always 59% 61% 56% 68% 72% Yes 91% 91% Always 61% 63% 2,790 Explain Blood Tests 2,788 Usually 24% 26% 19% No 9% Usually Sometimes 15% 15% Sometimes Never 2% 3% 2% Never 9% Correlation analysis of the survey results also identified the first three questions on this page also having strong impact on the overall satisfaction rating of staff. Page 10

13 Give You Written Information About Your Rights Dialysis Center Staff Review Your Rights With You Told You What to Do if Health Problem at Home Told You How to Get Off the Machine in an Emergency 100% 90% 80% 84% 86% 72% 73% 79% 79% 76% 79% 70% 40% 30% 0% (Prior year's results shown in faded colors) Give You Written Information About Your Rights Review Your Rights With You Told You What to Do if Health Problem at Home Told You How to Get Off the Machine in an Emergency Graphed N= 2,695 2,665 2,710 2,697 Yes 84% 86% 72% 73% 79% 79% 76% 79% No 16% 28% 21% 24% Page 11

14 The Dialysis Center Survey Questions Wait Time within 15 Minutes How often did you get put on the dialysis machine within 15 minutes of your appointment or shift time? As Clean as It Could Be How often was the dialysis center as clean as it could be? Page 12

15 100% 90% 80% 70% 40% 30% 0% Wait Time within 15 Minutes The Dialysis Center 39% 41% As Clean as It Could Be 100% 71% (Prior year's results shown in faded colors) Graphed N= Wait Time within 15 Minutes As Clean as It Could Be 2,706 2,716 Always 39% 41% 71% Usually Sometimes Never 31% 21% 22% 7% 8% 1% Correlation analysis of the survey results identifies "how often was the dialysis center as clean as it could be? " as having a strong impact on the overall satisfaction rating of the dialysis center. Maintaining a clean facility should be a high priority for facility staff. Page 13

16 Treatment Survey Questions Talk As Much As You Wanted about Treatment Options Did either your kidney doctors or dialysis center staff talk to you as much as you wanted about which treatment is right for you? Explained Why You Are Not Eligible for Kidney Transplant Have either your kidney doctors or dialysis center staff explained to you why you are not eligible for a kidney transplant? Talk About Peritoneal Dialysis Did either your kidney doctors or dialysis center staff talk to you about peritoneal dialysis? Involved in Choosing Treatment Option Were you as involved as much as you wanted in choosing the treatment for kidney disease that is right for you? Unhappy with Care Were you ever unhappy with the care you received at the dialysis center or from your kidney doctors? Talk with Staff about Unhappiness with Care Did you ever talk to someone on the dialysis center staff about this? Satisfied with the Way Problems Handled How often were you satisfied with the way they handled these problems? Make Complaint to Medicare or State Agencies Did you make a complaint to any of the Medicare or state agencies? Page 14

17 Talk As Much As You Wanted about Treatment Options Treatment Explained Why You Are Not Eligible for Kidney Transplant Talk About Peritoneal Dialysis Involved in Choosing Treatment 100% 90% 80% 70% 71% 74% 55% 58% 75% 78% 44% 44% 40% 30% 0% (Prior year's results shown in faded colors) Graphed N= Talk As Much As You Wanted about Treatment Options Explained Why You Are Not Eligible for Kidney Transplant Talk About Peritoneal Dialysis Involved in Choosing Treatment Option 2,660 1,082 2,611 2,629 Yes 71% 74% 55% 58% 44% 44% 75% 78% No 29% 45% 56% 25% Page 15

18 Unhappy with Care Talk with Staff about Unhappiness with Care Treatment Satisfied with the Way Problems Handled Make Complaint to Medicare or State Agencies 100% 90% 80% 70% 40% 30% 0% 25% 24% (Prior year's results shown in faded colors) 52% 69% 30% 32% 7% Graphed N= Unhappy with Care Talk with Staff about Unhappiness with Care Satisfied with the Way Problems Handled Make Complaint to Medicare or State Agencies 2, Yes 25% 24% 52% 69% Always 30% 32% Yes 7% No 75% 48% Usually 26% No 90% Sometimes Never 30% 14% Page 16

19 Additional Comments (Unsolicited) The following are samples of comments made by patients in addition to the responses they gave to the survey questions. The additional comments were all categorized by topic and identified as being either positive or negative in nature. Positive comments were most frequently about staff, while negative comments were most often about the facility. Overall Care Comments Positive Total Comments = 8 + I would like to say that on all questions with a choice of 0-10 when rating my doctors, center, and staff, I would choose "30" if it was available. I am very satisfied with my center and I feel that my doctors and staff are "the best"! I appreciate their knowledge and caring. + I would like to add that the total team at the dialysis center is the best I have ever encountered. Overall Care Comments Negative Total Comments = 15 - The dialysis center never calls me when my husband goes to the hospital. They never even call to tell me he got sick. The hospital ends up calling me. It should be their responsibility to let me know when they transport my husband. - The procedures are set at these centers and there are people that force themselves. People show up early and late and it becomes a ripple effect. Other people become annoyed and frustrated. I feel they need more discipline with time. Doctor Comments Positive Total Comments = 3 + The Doctor is excellent. + I am completely satisfied with his service. + My doctor is just the best. Doctor Comments Negative Total Comments = 14 - Always unhappy with doctors. - Kidney Doctors generally not interested in anything other than dialysis. - The Doctor never talks to me. He ignores me every time I try and talk to him about my treatment. He only really pays attention to me if I have one of my sons with me. He never gives me any updates on my health or explanations. Staff Comments Positive Total Comments = 12 + I feel that the staff at this center are very professional and helpful. + The best staff. + Love the staff. + The people that run this center are right there when you need someone to talk to and are always there to try and make it the best experience that it can be Staff Comments Negative Total Comments = 29 - Too many people with no experience. - Soon after the staff gets patients on the dialysis machines, they are on their cell phones texting and not observing the patients. - The staff treats patients as if they were dogs. If you tell them you have a headache or you don't feel well, they don't ask questions or try to help, they just call an ambulance. - Need to observe new techs much more carefully & longer before turned loose. Page 17

20 Additional Comments (Unsolicited) Facility Comments Positive Total Comments = 3 + I like this dialysis center. + They are very clean, knowledgeable and caring. Facility Comments Negative Total Comments = 31 - It gets quite cold in the center. - Sometimes the floor needs to be picked up, i.e. paper, tape, etc. - Gnat infested, floors need better cleaning and no air conditioning. - Floors are dirty, bathroom is dirty and dead bugs. There are blood spots on walls. Treatment Comments Negative Total Comments = 9 - Once hooked to the machine, you don t exist. - My concern are the fluids that they are using The fluids they are using are the two that they ask you not to use and they still continue to use it - I don t think there is enough information or classes about kidney problems compared to the information available about diabetes. Language Comments Negative Total Comments = 18 - Very few people at the center speak Spanish. - The dialysis center staff does not understand English. - Staff member s accents are often difficult for me to understand. - No one speaks Spanish at the dialysis center. - I think the problems with communication between my doctor and I is a result of the language barrier. He does not speak Spanish. Page 18

21 Patient Demographics Survey Questions How Long at Dialysis Center How long have you been getting dialysis at this dialysis center? Overall Health In general, how would you rate your overall health? Mental or Emotional Health In general, how would you rate your overall mental or emotional health? Comorbidities Are you being treated for high blood pressure? Are you being treated for diabetes or high blood sugar? Are you being treated for heart disease or heart problems? Patient Characteristics What is your age? Are you male or female? What is the highest grade or level of school that you hav... Are you of Hispanic or Latino origin or descent? What is your race? What language do you mainly speak at home? Page 19

22 Patient Demographics How Long at Dialysis Center N = 2,796 0% 25% 75% 100% Less than 3 months 1% At least 3 months but less than 1 year 19% At least 1 year but less than 5 years 56% 5 years or more 24% Overall Health Mental or Emotional Health N = 2,555 0% 25% 75% 100% N = 0% 2,692 25% 75% 100% Excellent 8% Excellent 19% Very good 18% Very good 27% Good 40% Good 35% Fair 35% Fair 19% Poor 9% Poor 3% Comorbidity Comorbidity Comorbidity High Blood Pressure Diabetes or High Blood Sugar Heart Disease or Heart Problems 0% 25% 75% 100% 0% 25% 75% 100% 0% 25% 75% 100% N = 2,755 N = 2,769 N = 2,751 Yes 82% Yes 54% Yes 45% No 18% No 46% No 55% 20

23 Patient Demographics Age N = 2,802 0% 25% 75% 100% 18 to 24 0% Gender 25 to 34 3% 35 to 44 7% Male 56% 0% 25% 75% 100% N = 2, to 54 16% Female 44% Yes 26% 55 to 64 26% No 74% 65 to 74 24% 75 or older 24% N = 2,502 American Indian or Alaska Native 5% Education Asian 7% 0% 25% 75% 100% N = 2,752 Black or African American 35% 8th grade or less 17% Native Hawaiian or Other Pacific Islander 4% Some high school, but did not graduate 16% White 49% High school graduate or GED 31% Some college or 2-year degree 23% Language Spoken at Home 4-year college graduate More than 4-year college degree Race 7% N = 2,785 6% English 72% Spanish Both English and Spanish equally Some other language 14% 7% 7% Hispanic Origin or Descent 0% 25% 75% 100% N = 2,676 0% 25% 75% 100% 0% 25% 75% 100% 21

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