Ambulatory CAHPS®: Fact Sheet

Ambulatory CAHPS® is a plan for future CAHPS® surveys that will provide users with a flexible, modular approach to patients assessing the quality of ambulatory care. The approach will examine different levels of health care while retaining valuable aspects of the current CAHPS® Health Plan Survey.

Contents

What Is Ambulatory CAHPS® (ACAHPS)?
Whose Quality Is Being Measured?
What Does ACAHPS Measure?
What Else Is in ACAHPS?
ACAHPS Modules: Preliminary Vision
Questionnaires: Preliminary Vision
Bottom Line: What Will Users Get?
Next Steps
For More Information

What Is Ambulatory CAHPS® (ACAHPS)?

Ambulatory CAHPS® is a plan for the next generation of CAHPS® surveys of patients' experiences with care. The idea behind ACAHPS is to provide users with a flexible, modular approach to assessing the quality of ambulatory care at different levels of the health care system while still retaining valuable aspects of the current CAHPS® Health Plan Survey.

The intent of this modular approach is to enable users to field questionnaires that meet their needs and that are suitable for their markets, yet yield results that are comparable to those of CAHPS® survey users in other markets. The data will be useful for both public reporting as well as for the detailed internal reporting and analysis required for quality improvement.

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Whose Quality Is Being Measured?

With ACAHPS, users will be able to assess patients' perceptions of care at one or more levels of the health care system:

• Health plans: The payer (and sometimes provider) of health care services in either fee-for-service or managed care arrangements, including all types of health insurance plans, preferred provider organizations, and health maintenance organizations.
• Group practices: Two or more practitioners legally organized as a medical group to deliver care under certain conditions.
• Sites of care: A particular geographic location or facility from which care is being delivered.
• Clinicians: The individual primary care practitioner or provider (e.g., physician, nurse practitioner) providing care to a particular patient regardless of the location.

These levels may exist within the same organization (e.g., in a highly integrated health maintenance organization), or they may be fairly separate entities. Some of these levels may overlap with each other: Clinician and site of care, for example, may be the same in the case of a solo physician practicing in an independent office. Finally, these four levels will not be relevant to all survey users: Group practices, for example, are not common in certain parts of the country.

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What Does ACAHPS Measure?

Based on our previous work, we have identified several functional areas that users may want to assess:

• Access (Getting Needed Care and Getting Care Quickly).
• Doctor Communication.
• Office Staff Courtesy, Helpfulness and Respect.
• Shared Decisionmaking.
• Coordination/Integration.
• Health Promotion and Education.
• Customer Service.

Some functions may apply to only one level of the health care system, while others are the responsibility of multiple levels of the health care system.

Why These Functions?

In identifying these functions, the CAHPS® Consortium used the following criteria:

• They are important to reaching and maintaining a high level of quality of care.
• They are important to consumers in selecting health care.
• They are aspects of care for which consumers are the best or only judge.

Next Steps: Input From Stakeholders

The CAHPS® team welcomes input from stakeholders on several issues that we will need to resolve in order to move forward with ACAHPS:

• Identifying additional functions. Is this the right set of functions? Is anything missing? Should anything be revised?
• Assigning accountability. Which level(s) of the health care system can and should be held accountable for each function?
• Identifying specific items for each function. Which items should be assigned to each function for a given level of the system? The CAHPS® team has developed and tested a fair number of items needed to measure these function and begun the process of identifying items for each function, but we will be seeking additional items as well as input on existing items.

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What Else Is in ACAHPS?

In addition to the functions, the survey modules will include questions to capture:

• Consumer's global evaluations: Ratings, which are more subjective than reports of experiences with care, reflect a patient or consumer's global experience at a particular level of the system. One example would be a rating of care received from a personal doctor.
• Characteristics of consumers or respondents to the survey: All surveys will include items that allow the sponsor to describe the respondents, e.g., gender, age, health status, and other demographics. Answers to these questions allow sponsors to compare the experiences of different groups of consumers (e.g., older vs. younger adults).
• Sample confirmation: Every survey will also include a short set of items to confirm that the consumer has actually experienced care provided by a specific level of the health care system.

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ACAHPS Modules: Preliminary Vision

The table below presents a preliminary vision of the ACAHPS modules. Each cell represents a set of survey items that can be used to assess performance in a given area (function or rating) for a given level of the health care system. (This table does not show the cells for respondent characteristics or sample confirmation.)

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ACAHPS Questionnaires: Preliminary Vision

For each level of the health care system, a questionnaire will consist of a set of core items and possibly one or more sets of supplemental items for relevant functions. This construct is similar to that of the current CAHPS® Health Plan Survey.

Core Items

Core items are those questions that must be included in the survey instrument in order to assess a function that is the responsibility of a specific level, obtain a global evaluation, define respondent characteristics, or obtain sample confirmation information. Within a given function, core items may be different for each level of the system.

The use of core items assures the comparability of results across survey users and the integrity of submissions to the National CAHPS® Benchmarking Database (NCBD) and NCQA's Quality Compass. In addition, core questions are needed to construct comparable composite measures (i.e., summary measures composed of items that assess the same concept).

Supplemental Items

Supplemental items allow users to obtain more information on a specific function or examine other characteristics of respondents. For example, users could add and analyze supplemental items to "drill down" into the causes of specific performance problems. Supplemental items could also address the concerns of a specific population with respect to a particular function. For example, to assess communication, the questionnaire could include core items that apply to all consumers as well as supplemental items regarding language access services for consumers with limited English proficiency.

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Bottom Line: What Will Users Get?

Although many combinations of ACAHPS modules are possible, the CAHPS® Consortium plans to simplify the task of constructing a survey by developing several sets of pre-packaged survey instruments and data collection protocols. These sets will be designed to address the most common applications we anticipate based on the market research we completed in 2003 as well as the input we receive from stakeholders in 2003 and 2004. We will also provide guidelines for reporting the results of these surveys to external and internal audiences.

In addition, we will design some simple decision trees to help users assess their needs and either choose one or more of the prepackaged surveys or build their own using the ACAHPS modules.

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Next Steps for ACAHPS Development and Implementation

To support the further development and implementation of this approach, the CAHPS® team will be eliciting comments from the public and stakeholders through:

• Requests for public comment.
• The Web site of the CAHPS® Survey Users Network (www.cahps-sun.org)
• Meetings with sponsors, users of the data, and other stakeholders.

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For More Information

To keep updated on our progress with ACAHPS, go to the Web site of the CAHPS® Survey Users Network (www.cahps-sun.org), which will have status reports as well as draft instruments and testing results as they become available.

To comment on or ask questions about this approach, you can contact:

Chuck Darby
E-mail: CDarby@ahrq.gov
Phone: (301) 427-1324

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Current as of March 2004

Internet Citation:

Ambulatory CAHPS®: Introduction. March 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/cahps/acahps.htm

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