CAHPS Clinician & Group Survey: Overview of the Questionnaires (Four-Point Scale)

CAHPS Clinician & Group Survey: Overview of the Questionnaires (Four-Point Scale) Available Questionnaires... 1 Core Items...1 Supplemental Items...2 Development of the Survey... 2 Appendix Exhibit 1: Topics Covered by the Core Items in the Adult Primary and Specialty Care Questionnaires 1.0 and the Child Primary Care Questionnaire 1.0...4 Exhibit 2: Topics Covered by the Core Items in the Child Primary Care Questionnaires 1.0 and 2.0 beta...6 Exhibit 3: Topics Covered by the Supplemental Items in the Adult Primary Care Questionnaire 1.0...9 Exhibit 4: Topics Covered by the Supplemental Items in the Adult Specialty Care Questionnaire...13 Exhibit 5: Topics Covered by the Supplemental Items in the Child Primary Care Questionnaires 1.0 and 2.0 (Beta)...15

Available Questionnaires The CAHPS Clinician & Group Survey includes the following four instruments: Adult Primary Care 1.0. Adult Specialty Care 1.0 Child Primary Care 1.0 Child Primary Care 2.0 (beta). All of these questionnaires use a four-point frequency scale of Never, Sometimes, Usually, and Always. If you prefer to use a six-point frequency scale (adding Almost never and Almost always ), please download the alternative Kit from https://www.cahps.ahrq.gov/cahpskit/cahpskit_main.asp. All instruments are available in both English and Spanish and formatted in a manner suitable for mailing. To learn more about the recommended format of a CAHPS questionnaire, please refer to Preparing a Questionnaire Using the CAHPS Clinician & Group Survey (Document No. 32). Beta Version of Child Primary Care Questionnaire 2.0 In the fall of 2008, the CAHPS Consortium released an expanded version of the Child Primary Care Questionnaire. This version includes two new composites for developmental care and preventive care, as well as some minor changes to existing items. While the Consortium gathers more information from users about this new instrument, both the 1.0 and 2.0 versions are available. To learn more about this new questionnaire, refer to About the Expanded Child Primary Care Questionnaire 2.0 (Beta) at https://www.cahps.ahrq.gov/cahpskit/files/1310_about_child_2-beta.pdf. Core Items Each instrument consists of a set of core items followed by a set of supplemental items. Core items are questions that are included in every questionnaire to ensure the standardization and comparability of results across survey sponsors. These items are designed to be applicable across populations. Sponsors who field the Clinician & Group Survey must include all of the core items from one of the three questionnaires. The core items in the Adult Primary Care and Adult Specialty Care questionnaires are identical; they ask respondents ages 18 and older about their experiences receiving care from their doctor and clinic. To review the topics covered in the adult questionnaires, refer to Exhibit 1. Page 1

The core items in the Child Primary Care Questionnaire 1.0 are substantively identical to the two adult questionnaires, but there are some differences. First, the child questionnaire asks parents or guardians to report on the health care experiences of their child. The child questionnaire also includes some additional demographic questions and does not include the four chronic condition screener items that can be found in both adult questionnaires. To review the topics covered in the Child Primary Care Questionnaire 1.0 in comparison to the Adult Questionnaires 1.0, refer to Exhibit 1. To compare the Child Primary Care Questionnaires 1.0 and 2.0 (Beta), refer to Exhibit 2. Supplemental Items Supplemental items are questions that may be added to the questionnaires to address specific areas of interest to the sponsors, such as experiences with prescription medicines or shared decisionmaking. Each of the Clinician & Group Survey s three questionnaires includes a unique set of supplemental items. To review the topics covered by each of the supplemental sets, refer to Exhibits 3 through 5. To compare the supplemental items for the Child Primary Care Questionnaires 1.0 and 2.0 (Beta), refer to Exhibit 5. To learn more about incorporating supplemental items into your questionnaire, refer to Preparing a Questionnaire Using the CAHPS Clinician & Group Survey (Document No. 32). Development of the Survey During the first phase of the CAHPS program (1996-2000), the CAHPS Consortium began work on a standardized, evidence-based instrument that would allow physicians and medical group administrators to assess and improve patients' experiences with their care. Working in collaboration with the Pacific Business Group on Health (PBGH), the Consortium developed a preliminary instrument known as the CAHPS Group Practice Survey (G-CAHPS). The Consortium used that instrument as a starting point for its development of the CAHPS Clinician & Group Survey during the second phase of the CAHPS program. Steps in the development process of the new instrument included the following: Interviews with stakeholders about their experiences with the Health Plan Survey and their information needs with respect to both physicians and groups. Consultation with PBGH and the Massachusetts Health Quality Partners, both of which had fielded their own group-level surveys. Page 2

The establishment of the Ambulatory CAHPS Advisory Group, a diverse panel of experts who have provided input on issues related to survey content and administration. The publication of a Call for Measures in the June 10, 2004, edition of the Federal Register. This allowed the Consortium to review the relevant work done by other organizations and assess potential domains to cover in the Clinician & Group Survey. Field testing with over a dozen organizations, including health plans, large medical groups, purchaser groups, physician boards, and others. Cognitive interviewing in English and Spanish to determine how potential respondents understood and reacted to survey questions. Several rounds of revision of the draft instrument based on feedback from field tests, cognitive interviews, and stakeholders. Endorsement of the instrument by the National Quality Forum as well as the Ambulatory Quality Alliance. To learn more about the development of the CAHPS Clinician & Group Survey, go to https://www.cahps.ahrq.gov/content/products/cg/prod_cg_cg40develop ment.asp. Page 3

Exhibit 1: Topics Covered by the Core Items in the Adult Primary and Specialty Care Questionnaires 1.0 and the Child Primary Care Questionnaire 1.0 Topic Confirmation of doctor Personal doctor identification Length of relationship Utilization Access to care Getting Needed Care Getting Care Quickly Provider communication Follow up on test results Short Item Title (Adult) (Child) Patient/[Child] * received care from doctor named below 1 1 Patient/[Child] usually sees this doctor for care 2 2 How long patient/[child] has been going to doctor 3 3 Number of times patient/[child] visited doctor for care in last 12 months Patient/[Child] got appointment for urgent care as soon as needed [for the child] Patient/[Child] got appointment for non-urgent care as soon as needed [for the child] Patient/[Respondent] got answer to medical question the same day he/she phoned doctor s office Patient/[Respondent] got answer to medical question as soon as he/she needed when phoned doctor s office after hours Patient/[Child] saw doctor within 15 minutes of appointment time Doctor explained things in a way that was easy to understand 4 4 6 6 8 8 10 10 12 12 13 13 14 14 Doctor listened carefully to patient/[respondent] 15 15 Doctor gave easy to understand instructions about taking care of health problems or concerns Doctor knew important information about patient s/[child s] medical history 17 17 18 18 Doctor respected patient s/[respondent s] comments 19 19 Doctor spent enough time with patient/[child] 20 20 Someone from doctor s office followed up with patient/[respondent] to give results of blood test, x-ray, or other test 22 22 * The test in brackets refers to language that appears in the Child Primary Care Questionnaire s version of these questions. Page 4

Exhibit 1: Topics Covered by the Core Items in the Adult Primary and Specialty Care Questionnaires 1.0 and the Child Primary Care Questionnaire 1.0 Topic Short Item Title (Adult) (Child) Global rating Rating of doctor 23 23 Clerks and Clerks and receptionists helpful 24 24 receptionists at doctor s office Clerks and receptionists courteous and respectful 25 25 Health status Rating of [child s] overall health 26 26 Screener items for patients with chronic conditions Patient has seen doctor or health provider 3 or more times for same condition or problem 27 -- Condition has lasted for at least 3 months 28 -- Patient needs or takes prescription medicine 29 -- Medicine was for condition that lasted for at least 3 months 30 -- Age [child] -- 27 Male or female [child] -- 28 Hispanic or Latino [child] -- 29 Race [child] -- 30 Demographic items Age of patient [respondent] 31 31 Patient/[Respondent] male or female 32 32 Highest grade level completed [respondent] 33 33 Hispanic or Latino 34 -- Race 35 -- Respondent s relationship to child -- 34 Proxy Someone helped patient/[respondent] complete survey 36 35 respondent items How that person helped 37 36 Page 5

Exhibit 2: Topics Covered by the Core Items in the Child Primary Care Questionnaires 1.0 and 2.0 beta Topic Short Item Title 1.0 Item # 2.0 (Beta) Confirmation of doctor Personal doctor identification Length of relationship Utilization Access to care Getting Needed Care Getting Care Quickly Provider communication with your child Provider communication Child received care from doctor named below 1 1 Child usually sees this doctor for care 2 2 How long child has been going to doctor 3 3 Number of times child visited doctor for care in last 12 months Respondent got appointment for urgent care as soon as child needed Respondent got appointment for non-urgent care as soon as child needed Respondent got answer to medical question the same day he/she phoned doctor s office Respondent got answer to medical question as soon as he/she needed when phoned doctor s office after hours 4 4 6 13 8 15 10 17 12 19 Child saw doctor within 15 minutes of appointment time 13 20 Doctor explained things in a way that was easy for child to understand -- 8 Doctor listened carefully to child -- 9 Doctor gave respondent enough information about what was discussed if respondent was not in exam room Doctor gave respondent enough information about follow-up care Doctor explained things in a way that was easy to understand -- 6 -- 11 14 21 Doctor listened carefully to respondent 15 22 Doctor gave easy to understand instructions about taking care of child s health problems or concerns 17 24 Page 6

Exhibit 2: Topics Covered by the Core Items in the Child Primary Care Questionnaires 1.0 and 2.0 beta Topic Follow up on test results Development Prevention Short Item Title Doctor knew important information about child s medical history 1.0 Item # 2.0 (Beta) 18 25 Doctor respected respondent s comments 19 26 Doctor spent enough time with child 20 27 Someone from doctor s office followed up with respondent to give results of child s blood test, x-ray, or other test Respondent and doctor talked about child s learning ability Respondent and doctor talked about age-appropriate behaviors Respondent and doctor talked about child s physical development Respondent and doctor talked about child s moods and emotions Respondent and doctor talked about how child gets along with others 22 29 -- 30 -- 31 -- 32 -- 33 -- 38 Respondent and doctor talked about injury prevention -- 34 Doctor gave written information on injury prevention -- 35 Respondent and doctor talked about child s eating habits -- 36 Respondent and doctor talked about child s physical activity Respondent and doctor talked about any problems in the household that might affect child -- 37 -- 39 Global rating Rating of doctor 23 40 Clerks and Clerks and receptionists helpful 24 41 receptionists at doctor s office Clerks and receptionists courteous and respectful 25 42 Health status Rating of child s overall health 26 43 Rating of overall mental or emotional health -- 44 Page 7

Exhibit 2: Topics Covered by the Core Items in the Child Primary Care Questionnaires 1.0 and 2.0 beta Topic Child demographic items Respondent demographic items Short Item Title 1.0 Item # 2.0 (Beta) Age of child 27 45 Child male or female 28 46 Child Hispanic or Latino 29 47 Child s race 30 48 Age of respondent 31 49 Respondent male or female 32 50 Highest grade level respondent has completed 33 51 Respondent s relationship to child 34 52 Proxy Someone helped respondent complete survey 35 53 respondent items How that person helped 36 54 Page 8

Exhibit 3: Topics Covered by the Supplemental Items in the Adult Primary Care Questionnaire 1.0 Topic Short Item Title Item Number After hours e-mail Being kept informed about appointment start Cost of care (prescriptions) Cost of care (tests) Patient e-mailed doctor s office with medical question Patient got answer to e-mail as soon as needed Patient was informed about length of wait time at doctor s office after checking in for appointment Patient took prescription medicine Patient was worried or concerned about cost of prescription medicine Patient and doctor talked about cost of prescription medicine Patient was worried or concerned about cost of blood tests, x-rays, or other tests Patient and doctor talked about cost of blood tests, x-rays, or other tests AE1 AE2 KI1 COC1 COC2 COC3 COC4 COC5 Doctor role Doctor is a specialist DR1 Doctor thoroughness Health improvement Health promotion and education Help with problems or concerns Doctor examined patient Doctor was as thorough as patient thought he/she needed Doctor talked about specific things patient could do to prevent illness Patient needed doctor s help in making changes to prevent illness Doctor gave patient help needed to make changes to prevent illness Doctor talked about healthy diet and eating habits Doctor talked about exercise or physical activity Doctor talked about worrying/stressful aspects of patient s life Doctor asked if patient had felt sad, empty or depressed Doctor helped with problems or concerns DT1 DT2 HI1 HP1 HP2 HP3 HP4 HP5 HP6 HPC1 Page 9

Exhibit 3: Topics Covered by the Supplemental Items in the Adult Primary Care Questionnaire 1.0 Topic Short Item Title Item Number Other doctors and providers at your doctor s office Provider communication Some appointments at this doctor s office in last 12 months were with other doctors/providers Other doctors/providers explained things in a way that was easy to understand Other doctors/providers listened carefully Patient discussed health problems or concerns with other doctors/providers Other doctors/providers gave easy to understand instructions about taking care of health problems or concerns Other doctors/providers respected patient s comments Other doctors/providers spent enough time with patient Other doctors/providers had all the information they needed to provide patient s care Rating of care provided by other doctors/providers Doctor encouraged patient to discuss health concerns Doctor s explanations about what was wrong with patient, reason for a treatment, etc. hard to understand Doctor s explanations hard to understand because of doctor s accent or way of speaking English Patient felt doctor really cared about him/her as a person Doctor ignored what patient told him/her Doctor used condescending, sarcastic, or rude tone or manner with patient Doctor showed interest in patient s questions or concerns Doctor listened to reasons for patient s visit, showed concern for patient s physical comfort, etc. Doctor gave patient complete and accurate information about tests, choices for care, etc. OD1 OD2 OD3 OD4 OD5 OD6 OD7 OD8 OD9 C1 C2 C3 C4 C5 C6 C7 C8 C9 Page 10

Exhibit 3: Topics Covered by the Supplemental Items in the Adult Primary Care Questionnaire 1.0 Topic Short Item Title Item Number Provider knowledge of specialist care Recommend doctor Shared decisionmaking Wait time for urgent care Your care from specialists in the last 12 months Your most recent visit Doctor suggested patient see specialist Doctor seemed informed and up-to-date about patient s care from specialists Patient would recommend doctor to family and friends How doctor s office could have improved care and services Doctor told patient that there were multiple choices for treatment or care Doctor talked about pros and cons of each choice for patient s treatment or care When there were multiple choices for treatment or care, doctor asked patient which he/she thought was best How long patient usually had to wait to get an urgent care appointment after contacting doctor s office Patient made appointments with specialists in last 12 months Easy to get appointments with specialists Doctor and patient discussed cost of seeing a specialist Patient was worried or concerned about cost of seeing a specialist Number of specialists patient has seen in last 12 months Specialists that patient saw knew important information about patient s medical history Rating of specialist seen most often in last 12 months Specialist seen most often was same as doctor named in Question 1 During most recent visit, patient kept informed about wait-time for appointment During most recent visit, patient saw doctor within 15 minutes of appointment time During most recent visit, doctor explained things in a way that was easy to understand PK1 PK2 RC1 RC2 SD1 SD2 SD3 WU1 SC1 SC2 SC3 SC4 SC5 SC6 SC7 SC8 RV1 RV2 RV3 Page 11

Exhibit 3: Topics Covered by the Supplemental Items in the Adult Primary Care Questionnaire 1.0 Topic Short Item Title Item Number During most recent visit, doctor discussed health problems or concerns with patient During most recent visit, doctor gave easy to understand instructions about taking care of health problems or concerns During most recent visit, doctor knew important information about patient s medical history During most recent visit, doctor showed concern about patient s health and way he/she was feeling During most recent visit, doctor spent enough time with patient During most recent visit, clerks and receptionists were courteous and respectful Rating of medical care received during most recent visit How doctor s office could have improved care and services at most recent visit RV4 RV5 RV6 RV7 RV8 RV9 RV10 RV11 Page 12

Exhibit 4: Topics Covered by the Supplemental Items in the Adult Specialty Care Questionnaire Topic Short Item Title Item Number Care you got from this doctor Coordinating your care Cost of care (prescriptions) Doctor role Shared decisionmaking Surgery or procedures done by this doctor Doctor checked to be sure patient understood everything Doctor encouraged patient to ask questions Doctor let patient talk without interruptions Doctor talked about specific things patient could do to manage his/her condition Rating of doctor s knowledge of patient as a person, including values and beliefs Doctor examined patient Doctor was as thorough as patient thought he/she needed Doctor talked with patient about all of the prescription medicines he/she was taking Patient took prescription medicine Patient was worried or concerned about cost of prescription medicine Doctor s role in patient s care was ongoing, one-time consultation, or other Doctor told patient that there were multiple choices for treatment or care Doctor talked with patient about pros and cons of each choice for treatment or care When there were multiple choices for treatment or care, doctor asked patient which he/she thought was best Doctor performed surgery or procedure on patient Doctor gave patient enough information on surgery or procedure before it was done Doctor made sure patient had enough pain relief during surgery or procedure Doctor gave patient pain relief medication after surgery or procedure DC1 DC2 DC3 DC4 DC5 DC6 DC7 CC1 COC1 COC2 DR1 SD1 SD2 SD3 SP1 SP2 SP3 SP4 Page 13

Exhibit 4: Topics Covered by the Supplemental Items in the Adult Specialty Care Questionnaire Topic Short Item Title Item Number Patient phoned doctor s office for help or advice after surgery or procedure Patient got needed medical help or advice when he/she phoned doctor s office after surgery or procedure SP5 SP6 Page 14

Exhibit 5: Topics Covered by the Supplemental Items in the Child Primary Care Questionnaires 1.0 and 2.0 (Beta) Topic Short Item Title 1.0 2.0 (Beta) After hours care Respondent tried to get after hours care for child at doctor s office After hours care at doctor s office met respondent s needs AH1 AH2 AH1 AH2 Behavioral health Overall mental or emotional health status MH1 Core #44 Child needs or takes prescription medicine -- CC1 Screening items for children with chronic conditions Medicine was for condition that lasted for at least 12 months Child needs or uses more services or medical care than most children the same age Services or medical care was for condition that lasted for at least 12 months Child limited in ability to do things most children the same age can do Limitation due to condition that lasted for at least 12 months Child needs or gets special therapy -- CC2 -- CC3 -- CC4 -- CC5 -- CC6 -- CC7 Therapy for a condition that lasted for at least 12 months -- CC8 Doctor communication with child Child needs or gets treatment or counseling for emotional, developmental or behavioral problem Treatment or counseling for a condition that is expected to last for at least 12 months Child is able to talk with doctors about his/her health care Doctor explained things in a way that was easy for child to understand -- CC9 -- CC10 DC1 Core #7 DC2 Core #8 Page 15

Exhibit 5: Topics Covered by the Supplemental Items in the Child Primary Care Questionnaires 1.0 and 2.0 (Beta) Topic Short Item Title 1.0 2.0 (Beta) Doctor encouraged child to ask questions DC3 DC3 Doctor listened carefully to child DC4 Core #9 Doctor communication Doctor encouraged respondent to ask questions -- DP1 Doctor thoroughness Doctor examined child DT1 DT1 Doctor was as thorough as respondent thought child needed DT2 DT1 Health improvement Identification of site of visit Doctor talked about specific things respondent could do to prevent illness in child Health center child visited HI1 -- -- ID1 Prescription medicines Doctor talked with respondent about all the prescription medicines child was taking PM1 PM1 Provider knowledge of specialist care Doctor suggested child see specialist for a particular health problem Doctor seemed informed and up-to-date about care child got from specialists PK1 PK2 PK1 PK2 Doctor told respondent that there were multiple choices for child s treatment or care SD1 SD1 Shared decisionmaking Doctor talked with respondent about pros and cons of each choice for child s treatment or care Doctor gave respondent enough information about each choice SD2 SD3 SD2 SD3 Doctor asked respondent which choice he/she thought was best for child SD4 SD4 Page 16