Development of Supplemental Quality Improvement Items for the Consumer Assessment of Healthcare Providers and Systems (CAHPS)

by Denise D. Quigley, Donna O. Farley, Julie A. Brown, Marc N. Elliott, Han de Vries, Ron D. Hays


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The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) was initiated by the Agency for Healthcare Research and Quality (AHRQ) in 1995 to establish survey and reporting products that provide consumers information on health plan and provider performance as judged by other consumers who have used the health plan. It was learned during the first CAHPS development work that various stakeholders have very different perspectives and uses for CAHPS. AHRQ initiated a second CAHPS project (CAHPS® II) in 2002, working with a consortium of RAND Corporation, American Institutes for Research, the Harvard Medical School, and Westat, to address concerns expressed by health plans and health care providers that CAHPS does not provide them the information they need to improve performance in areas of importance to consumers.

Using a structured consensus process, RAND worked with health plans to identify the specific issues of concern to them regarding the usability of CAHPS results for quality-improvement actions. Results of interviews with health plans confirmed their desire to have supplemental items available that they could use to collect more action-oriented data for quality improvement. In response to this issue, priority domains — coordination of care, access to care, information and materials, and customer service — and topic areas for item development were identified, and items for those areas were developed and field-tested.

Table of Contents

  • Chapter One

    The Context: Making CAHPS More Usable for Quality Improvement

  • Chapter Two

    Diagnosing the Problem

  • Chapter Three

    Identifying Priority Topic Areas

  • Chapter Four

    Developing Specific Items Within the Priority Topic Areas

  • Chapter Five

    Testing Candidate Supplemental QI Items for CAHPS

  • Chapter Six

    Discussion and Conclusion

  • Appendix A

    Design and Methods for the Health Plan Interviews

  • Appendix B

    Reliability of Ratings of Importance of QI Items

  • Appendix C

    New CAHPS Supplemental Items for Quality Improvement

  • Appendix D

    Supplemental Quality Improvement (QI) Items in the Field Test

  • Appendix E

    Correlations of Supplemental QI Items

The research described in this report was carried out in RAND Health, a division of the RAND Corporation. This work was sponsored by the Agency for Healthcare Research and Quality.

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