CAHPS and Comments

How Closed-Ended Survey Questions and Narrative Accounts Interact in the Assessment of Patient Experience

Published in: Journal of Patient Experience 2017, Vol. 4(1) 37-45. DOI: 10.1177/2374373516685940

by Steven C. Martino, Dale Shaller, Mark Schlesinger, Andrew M. Parker, Lise Rybowski, Rachel Grob, Jennifer L. Cerully, Melissa L. Finucane

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To investigate whether content from patient narratives explains variation in patients' primary care provider (PCP) ratings beyond information from the closed-ended questions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores.


Members of a standing Internet panel (N = 332) were randomly assigned to complete a CAHPS survey that was either preceded or followed by a set of open-ended questions about how well their PCP meets their expectations and how they relate to their PCP.


Narrative content from healthier patients explained only an additional 2% beyond the variation in provider ratings explained by CAHPS composite measures. Among sicker patients, narrative content explained an additional 10% of the variation. The relative placement of closed- and open-ended questions had little impact on narratives or CAHPS scores.


Incorporating a protocol for eliciting narratives into a patient experience survey results in minimal distortion of patient feedback. Narratives from sicker patients help explain variation in provider ratings.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

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