New tools for evaluating quality, value of health care from patient's perspective

Special issue of Medical Care provides update on tools for measuring health care quality from the patient's perspective

An ongoing program is developing new tools for assessing health care quality from the most important viewpoint-that of the patient receiving care, according to a special supplement to Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue presents a progress report on the Consumer Assessment of Healthcare Providers and Systems (CAHPS-) surveys -an Agency for Healthcare Research and Quality (AHRQ) initiative to capture patients' perspectives on healthcare. The ten papers in the special issue describe the development and evaluation of new CAHPS rating tools, explore the reasons for differences and quality ratings using CAHPS surveys, and report on some of the ways CAHPS data are being used for quality improvement.

Tools Lead to New Understanding, New Approaches to Quality Improvement

The CAHPS project seeks to move beyond simple patient satisfaction surveys by asking patients about their experiences with health care services. "CAHPS survey data are used to monitor health care quality, help consumers select providers and for quality improvement," according to an introductory article by Paul D. Cleary, PhD, of Yale School of Public Health and colleagues. Various CAHPS surveys have been created, following a rigorous development and testing process, to assess consumer experiences with care provided in different settings and facilities.

The ten articles in the special issue describe some recent work by CAHPS investigators in three areas:

• New CAHPS Surveys.-One survey under development assesses the "patient-centered medical home"-seen as a key concept in improving patient access to and satisfaction with medical care. Other new surveys address patients' experiences with health information technology, including doctors' use of computers during visits, health websites, and e-mail communications; families' perspectives on nursing home care; and experiences with outpatient medical visits, highlighting the importance of good doctor-patient communication.
• Sources of Variation in Care Ratings.-Explaining differences in ratings is a key factor in understanding how CAHPS ratings can be used to improve patient care. New studies compare ratings for adults versus children within health care centers, examine the effects of racial/ethnic differences on patient experiences with Medicare Part D, and explore the effects of cultural competency on patient experiences with hospital care.
• Use of CAHPS Data for Quality Improvement.-Three papers report on projects using CAHPS survey data to make improvements in health care quality. Two studies look at how patients use physician quality ratings and performance data to choose a primary care doctor; another looks at how joining a "quality collaborative" affects the quality climate and patient experiences with care at medical practices.

"We hope that this special issue provides the reader with information on new CAHPS developments and their potential to improve ongoing efforts to monitor and improve health care in the U.S.," Dr. Cleary and co-authors write. As part of its focus on new research affecting health care administration and delivery, Medical Care presents occasional updates on the development and evaluation of CAHPS surveys-including a supplement on CAHPS tools for assessing culturally competent care and health literacy, published earlier this year.

The products of a public-private program led by the AHRQ, the CAHPS surveys are important tools for evaluating the quality and value of health care from the patient's perspective. The surveys are freely available for download for health care consumers, providers, purchasers, or others interested in evaluating patient experiences with care.