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. 2014 Jun 6;9(6):1099-108.
doi: 10.2215/CJN.10121013. Epub 2014 May 15.

Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey

Robert Wood  1 , Carly J Paoli  2 , Ron D Hays  3 , Gavin Taylor-Stokes  4 , James Piercy  4 , Matthew Gitlin  2
Affiliations

Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey

Robert Wood et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: The US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients.

Design, setting, participants, & measurements: Data were drawn from the Adelphi CKD Disease Specific Program (a retrospective, cross-sectional survey of nephrologists and patients). Selected United States-based nephrologists treating patients receiving hemodialysis completed patient record forms and provided information on their dialysis center. Patients (n=404) completed the CAHPS-ICH survey (comprising 58 questions) providing six scores for the assessment of patient experience of care. CAHPS-ICH item-scale convergence, discrimination, and reliability were evaluated for multi-item scales. Floor and ceiling effects were estimated for all six scores. Patient (demographics, dialysis history, vascular access method) and facility characteristics (size, ratio of patients-to-physicians, nurses, and technicians) associated with the CAHPS-ICH scores were also evaluated.

Results: Item-scale correlations and internal consistency reliability estimates provided support for the nephrologists' communication (range, 0.16-0.71; α=0.81) and quality of care (range, 0.16-0.76; α=0.90) composites. However, the patient information composite had low internal consistency reliability (α=0.55). Provider-to-patient ratios (range, 2.37 for facilities with >36 patients per physician to 2.8 for those with <8 patients per physician) and time spent in the waiting room (3.44 for >15 minutes of waiting time to 3.75 for 5 to <10 minutes) were characteristics most consistently related to patients' perceptions of dialysis care.

Conclusions: CAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.

Keywords: CAHPS-ICH; hemodialysis; patient experience of care; quality of care; reimbursement.

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References

    1. US Centers for Medicare and Medicaid Services: End Stage Renal Disease (ERSD) Quality Initiative. Available at: http://www.cms.gov/Medicare/End-Stage-Renal-Disease/ESRDQualityImproveIn... Accessed February 6, 2013
    1. US Centers for Medicare and Medicaid Services. US Department of Health and Human Services : Medicare program; end-stage renal disease prospective payment system and quality incentive program; ambulance fee schedule; durable medical equipment; and competitive acquisition of certain durable medical equipment prosthetics, orthotics and supplies. Final rule. Fed Regist 76: 70228–70316, 2011 - PubMed
    1. US Centers for Medicare and Medicaid Services. US Department of Health and Human Services : Medicare program; end-stage renal disease prospective payment system, quality incentive program, and durable medical equipment, prosthetics, orthotics, and supplies; proposed rule. Fed Regist 78: 40836–40890, 2013 - PubMed
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    1. US Department of Health and Human Services: Health information privacy. Available at: http://www.hhs.gov/ocr/privacy/ Accessed February 8, 2013

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