This article is part of the HHCN+ membership
Consumer ratings from the Healthcare Provider and Systems (CAHPS) Survey are an important tool for measuring the experience of home hygiene patients. However, these studies are often complicated and can be an unreliable feedback method due to low patient response rates.
Although home health providers, particularly small organizations, may struggle to implement and utilize CAHPS data, the findings play a key role in promoting consumer notification, support for quality improvement efforts, and value-based purchasing initiatives by organizations such as the Centers for Medicare and Medicaid Services (CMS).
“The CAHPS survey provides valuable insight into how well they meet (patients) expectations,” Erin Volbeda, Vice President of Marketing and Communications at Enhabit, told Home Health Care News. “We use this feedback to not only promote improvement, but also recognize and congratulate clinicians when patient insights emphasize exceptional care. This is a meaningful way to strengthen our culture of compassion and excellence.”
Dallas-based Enhabit currently operates 249 home sanitation sites and 114 hospice locations in 34 states.
Supported by the Agency for Healthcare Research and Quality (AHRQ), CAHPS survey assesses key factors in healthcare quality, including communication between patients and providers, ease of access, customer service from health plans, and coordination between providers.
The provider said it uses CAHPS data to improve care, support patient decision-making, promote accountability and promote performance-based payments for high-quality services.
CMS considers CAHPS as a gold standard for measuring the quality of patient experiences, using data in its value-based programs to influence provider payments
The transition to payment providers within value-based care systems rather than service charge models emphasizes the importance of assessing patient experiences with healthcare providers.
CAHPS research also helps providers take responsibility for inadequate care managers. A patient complaint can identify concerns about the facility or provider. If the provider consistently scores a low score in the survey, the CMS may be notified of these issues and may decide to investigate.
Converts data into meaningful results
Enhabit Home Health and Hospice uses these survey responses in the Quality Assurance and Performance Improvement (QAPI) process to identify opportunities to enhance care delivery, according to Erin Volbeda, Vice President of Marketing and Communications.
“These insights help guide clinical teams' targeted education and strengthen best practices that match patients' expectations and experiences,” she told Home Healthcare News.
Similarly, Centerwell Home Health develops action items or customer service initiatives built into the QAPI program using comments and overall scores from the survey.
“Comments and performance metrics are reviewed monthly, and action items are updated and implemented at least quarterly based on survey results and trends,” she said. “Educating patients about the likelihood of receiving a survey and completing the survey is important to us, so it's important to have a successful CAHPS programme.”
Centrewell is Humana's provider services division, including home hygiene, pharmacy and primary care.
According to an AHRQ spokesman, AHRQ provides resources such as the CAHPS database and outpatient care improvement guide to help organizations use their results for quality improvement, while new research, supplementary items sets and patient narrative tools reflect on the ongoing innovation of the program.
When deciding how to translate CAHPS findings into meaningful quality improvements, the most challenging aspect is knowing where to start. According to Katie Wehri, vice president of Katie Wehri (Alliance), Vice President of Regulatory Issues, Quality and Compliance, providers need to identify which questions from the survey will most impact.
“Because of the workforce and operational challenges facing them, they must be efficient and effective in their work, so identifying and focusing on the areas that have the most impact on their scores will give you the best results,” Wehri told HHCN.
To identify the most influential questions, Wehri suggested that providers ask the research vendor for the correlation coefficient of the questions. This shows the strength of the relationship between the top box score for each question and the overall agency rating. You can also carefully review questions that are inversely proportional to your score, but you may need to have a detailed analysis of compound questions linked to performance measurements.
Once the focus area is identified, the agency can create an improvement plan.
“The team needs to be involved in this process. Once that goal is defined and maintained, it's important to maintain that goal at its best,” Wheri says. “Continuous communication about progressing towards your goals and maintaining them once they are achieved is essential for long-term success.”
assignment
Despite the value of these studies, researchers at RTI International identified challenges in implementing and sharing results.
One common challenge is low response rates. Response rates are often used as an indicator of how well the data represents the population. According to RTI, higher response rates improve the validity of the survey results, greater likelihood that the survey results can be applied to the target group, and lower the risk of non-response bias. Overall, response rate slips have become a concern for research researchers, which are shared sentiments by CAHPS survey users, stakeholders, sponsors, clinicians and accredited organizations.
CMS Data | CC0
“Providers using CAHPS surveys often encounter challenges such as limited details from standardized questions, delays in receiving results, data interpretation, difficulty in resource constraints, especially for small organizations,” an AHRQ spokesman told HHCN. “However, despite these barriers, Cahps research remains essential. It offers a consistent, standardized way to capture what is most important to patients, identify opportunities for improvement, and complement other measures such as patient-reported outcome measures to give them a more complete understanding of the quality of care.”
However, as response rates continue to decline, the costs for home health providers obtain completed surveys from patients will increase. Sample sizes are an important factor affecting the cost of surveying mail and telephone methods, and lower response rates require a larger sample size.
RTI researchers noted that using previous information to reduce variance may be possible to obtain accurate estimates without increasing sample size.
RTI conducted a preliminary survey to measure key estimate changes between completed email surveys from the complete email protocol, a multi-step standardization process designed to maximize survey response rates and data quality, and key email surveys from the first month of fielding alone. National and large-scale regional forecasts were roughly the same when comparing the first month with the full email protocol. It was concluded that the current method allows providers with larger sample sizes to reduce sample size without sacrificing accuracy.
Researchers noted that incorporating new measures into these studies can be challenging. However, research should now be relevant by including new questions focusing on the most important aspects of care for patients and providers.
The new questions should follow the principles of clarity and accuracy of CAHPS measurement science and focus on whether respondents observed providers who exhibited specific behaviors without their expectations or individual quirks affecting their responses. However, adding new questions often leads to longer research, and researchers say it can discourage people from completing them.
AHRQ began examining how length of the survey influences the effectiveness and cost of data collection, and the relationship between overall response rates. However, findings on the relationship between survey length and response rates show a variety of results.
According to Wehri, changes have been made to the Cahps Hospice Survey recently to reduce the number of questions, update the wording, and provide web-based options for caregivers' responses.
“These are welcome changes that the hospice community has been demanding, but whether they have succeeded in meeting one of the CMS' goals will tell you whether they will improve the survey's response rate,” Wehri said. “Perhaps the biggest challenge in improving CAHPS scores and quality of care is the time required to see results from efforts. This is especially important to gather feedback outside of the survey, such as real-time patient surveys.”
Agency seeking this real-time information from patients must adhere to CMS CAHPS guidelines on communications that may inappropriately affect CAHPS investigations, Wehri said. However, within the parameters there is a feedback option that allows for more timely action when dealing with potential misconceptions and issues.
Opportunities for improvement
Some CMS programs address the issue of low response rates by distributing educational materials such as flyers and posters to patients through providers. These materials explain the basic purpose and legitimacy of the investigation. Approval from a trusted provider informs that this is a legitimate investigation and can be meaningful to whether to complete it in a patient's decision. Home health institutions with high employee involvement are tax, advisory and consulting firms, and are more likely to experience high patient and caregiver satisfaction scores, according to a report from Berrydunn sponsored by Strategic Health Programs and Alliances.
“We will actively educate patients and their caregivers about the purpose and importance of the CAHPS survey,” Volveda said. “We will strengthen our commitment to encouraging participation and providing exceptional care by highlighting how their feedback directly informs quality improvement efforts.”
Rain emphasized the importance of communication and care coordination as an important component of CAHPS survey questions. To get positive results in the CAHPS survey, these two clinical skills need to be fully implemented, she said.
“To do that, we will educate our clinical peers on evidence-based communication strategies for 'motivation interviews' and 'teachback methods',” she said. “These established strategies are to meet patients with patients and gather opinions from them in ways that make sense to them. We listen and act on what they are saying when guiding coordination of care.
Additionally, according to Rains, Centerwell has been continuously updating and strengthening documentation of care coordination in case conference processes and medical records.
The number of surveys received by recipients has also been identified as a factor in lower response rates. In the CAHPS survey of home health, outpatient surgery and dialysis environments, CMS specifies that a person can sample less than twice a year.
Currently, CMS makes it possible to manage electronically primarily through a mixed mode approach, using data collected by CMS-approved research vendors, primarily via a mixed mode approach. After the survey, the agency acknowledged that electronic options could provide patients with more options and improve response rates and data collection.
However, even online research can pose challenges for providers like Enhabit.
“The key challenge is ensuring research accessibility for patients with cognitive or functional limitations, or for patients living in assisted living facilities where research can be more difficult to complete,” Volveda said. “Coordination of communication and care is a key factor in the patient's experience.”
