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

Posted on RAND.org on April 07, 2017

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

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Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

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