Differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey Scores by Recency of the Last Visit

Implications for Comparability of Periodic and Continuous Sampling

Published in: Medical Care, Volume 57, Issue 12, pages e80–e86 (December 2019). doi: 10.1097/MLR.0000000000001134

Posted on RAND.org on March 18, 2020

by Claude Messan Setodji, Q. Burkhart, Ron D. Hays, Denise D. Quigley, Samuel A. Skootsky, Marc N. Elliott

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Patient experience data can be collected by sampling patients periodically (eg, patients with any visits over a 1-year period) or sampling visits continuously (eg, sampling any visit in a monthly interval). Continuous sampling likely yields a sample with more frequent and more recent visits, possibly affecting the comparability of data collected under the 2 approaches.


To explore differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey (CGCAHPS) scores using periodic and continuous sampling.

Research Design

We use observational data to estimate case-mix-adjusted differences in patient experience scores under 12-month periodic sampling and simulated continuous sampling.


A total of 29,254 adult patients responding to the CGCAHP survey regarding visits in the past 12 months to any of 480 physicians, 2007–2009.


Overall doctor rating and 4 CG-CAHPS composite measures of patient experience: doctor communication, access to care, care coordination, and office staff.


Compared with 12-month periodic sampling, simulated continuous sampling yielded patients with more recent visits (by definition), more frequent visits (92% of patients with 2+ visits, compared with 76%), and more positive case-mix–adjusted CAHPS scores (2–3 percentage points higher).


Patients with more frequent visits reported markedly higher CG-CAHPS scores, but this causes only small to moderate changes in adjusted physician-level scores between 12-month periodic and continuous sampling schemes. Caution should be exercised in trending or comparing scores collected through different schemes.

Research conducted by

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