Evaluation of Proposed New Measures for the Hospital CAHPS Survey

Background

Since its 2006 launch, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become the most used hospital patient experience survey, included in public reporting and accountability systems. Responding to emerging evidence of possible gaps in survey content, the Centers for Medicare & Medicaid Services undertook extensive efforts to develop and test new HCAHPS measures.

Objectives

Describe the development and testing of new HCAHPS measures.

Research Design

Activities supporting the development and refinement of survey items and measures included 4 patient focus groups, 27 cognitive interviews, and a 12-member technical expert panel. Psychometric testing of proposed survey items and measures used data from a 2021 large-scale randomized experiment.

Results

Patient focus groups, cognitive testing, psychometric analyses, and a technical expert panel supported the addition of 2 new multi-item measures (Care Coordination and Restfulness of Hospital Environment), a new single-item measure (Information about Symptoms), and the placement of one current HCAHPS item (Quietness) within one of the new composite measures. All proposed measures had strong psychometric properties, including good construct validity and hospital-level reliabilities that ranged from 0.73 for the Information about Symptoms standalone measure to 0.87 for Restfulness of Hospital Environment. Cronbach alpha for the 3 new or modified composite measures ranged from 0.74 to 0.76.

Conclusions

The new content would broaden HCAHPS by adding new aspects of care that are important to patients. The public reporting of the new measures and their role in payment may support hospital quality improvement efforts.