Development and Evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Survey for In-Center Hemodialysis Patients
Published In: American Journal of Kidney Diseases, 2014
Posted on RAND.org on January 01, 2014
BACKGROUND: The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey. STUDY DESIGN: We conducted formative research to generate survey questions and performed statistical analyses to evaluate the survey's measurement properties. SETTING & PARTICIPANTS: Formative research included focus groups, cognitive interviews, and field testing the survey with dialysis patients. MEASUREMENTS & OUTCOMES: We assessed internal consistency reliability (Cronbach alpha) and center-level reliability for 3 multi-item scales. We evaluated construct validity using correlations of the scales with global ratings of the kidney doctor, staff, and dialysis center. RESULTS: Response rate was 46% (1,454 completed surveys). Analyses support 3 multi-item scales: Nephrologists' Communication and Caring (7 items, alpha = 0.89), Quality of Dialysis Center Care and Operations (22 items, alpha = 0.93), and Providing Information to Patients (11 items, alpha = 0.75). The communication scale was correlated the most strongly with the global rating of the "kidney doctor" (r = 0.78). The Dialysis Center Care and Operations scale was correlated most strongly with global ratings of staff (r = 0.75) and the center (r = 0.69). Providing Information to Patients was correlated most strongly with the global rating of the staff (r = 0.41). LIMITATIONS: A relatively small number of patients completed the survey in Spanish. CONCLUSION: This study provides support for the reliability and validity of the CAHPS In-Center Hemodialysis Survey for assessing patient experiences of care at dialysis facilities. The survey can be used to compare care provided at different facilities.