CAHPS®, the Consumer Assessment of Health Plans, is an easy-to-use kit of survey and report tools that provides people with objective information to help them assess and choose among health plans. The kit contains a set of questionnaires to ask enrollees about their experience with and assessment of their health plans, recommended formats for analyzing and reporting results, and a handbook to help implement the surveys and reports.
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Developing the Survey /
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The CAHPS® design resulted from years of research into what qualities are important to people when they choose health plans and how to assess these qualities. The success of CAHPS® to date is a testament to the importance of sustained basic and applied health services research in producing practical information for everyday health decisionmaking. Select for the CAHPS® Fact sheet.
Before researchers could develop a useful tool to assess consumers' own health care experience, they had to understand how to measure these experiences in ways that gave them valid, reliable results.
Researchers needed to know, for example, why two seemingly similar questions about someone's health sometimes led to very different answers. Since the 1970s, the Agency for Healthcare Research and Quality (AHRQ) and other agencies within the Department of Health and Human Services have supported studies and conferences that address these and similar questions.
Pretesting survey questions. One discovery from these early research efforts was the critical importance of testing the ways in which ordinary people interpreted proposed survey questions. Researchers discovered that even seemingly straightforward questions which were reliable in field administration often meant very different things to different people in ways the researchers could not anticipate. As a result, testing peoples' interpretations of questions became a standard step in health survey development; and such tests were key in the development of CAHPS®.
Understanding people's needs. Another stream of research investigated what people care about when making health care choices: What kinds of information do people say are important to their decisions? What information do they actually use? Finally, research on effective communication strategies and reporting formats addressed questions on how information should be presented to make it understandable, practical, and useful at the time people want it. These investigations yielded a critical finding: that is, often the information most useful to consumers is information that comes from consumers.
Employing the consumer perspective. In a 1994 review of existing consumer health care surveys, AHRQ researchers found that, although many of these surveys were well-designed for their specific purposes, there was no standard set of consumer-based measures that was widely applicable. In addition, those surveys had been developed to meet the information needs of health plans and purchasers, not to inform consumers; and, as prior research had shown, what consumers want to know is not always equivalent to what plans and purchasers want to know.
These and other results of basic health care survey research were discussed in a 1994 conference, jointly sponsored by AHRQ and the Robert Wood Johnson Foundation. The conclusion:
AHRQ subsequently has committed more than $15 million to a 5-year effort to develop surveys and reports that will inform consumers about health care quality from their own perspective.
Ensuring utility. Three teams of experts from Harvard Medical School, RAND, and Research Triangle Institute, working cooperatively with AHRQ, designed and rigorously tested a new survey and reporting instrument. Designing the survey questions and the reporting format simultaneously helped ensure that the results of the survey would be presented in a useful and meaningful way.
Research at the survey and report design stage was critical to refining the survey questions. Most individual consumers, for example, want to know whether a plan covers physicians and hospitals that are conveniently located. However, what is convenient to a person who fills out the survey is not necessarily convenient to another who reads the results. Thus the CAHPS® researchers discovered that survey questions which inquired about "provider convenience" were not very helpful to survey users. These questions ultimately were eliminated from the CAHPS® questionnaire.
CAHPS® is a practical tool because of its ease of use, ongoing involvement of public and private partners, and built-in evaluation component.
Ease of use. The CAHPS® Survey and Reporting Kit provides any interested health care purchaser with everything required to field the survey and report the results. To make the kit especially user-friendly, survey questionnaires, a data analysis program, and report templates are given in electronic form. A toll-free number for ongoing technical assistance is also provided.
Partnerships. During the development of CAHPS®, AHRQ worked with two partners to adapt the survey to meet their specific needs.
Evaluation. Assessing the utility and impact of the survey is integral to CAHPS®. Users of the survey participate in a voluntary network that routinely provides feedback to AHRQ. Users' suggestions are incorporated when the CAHPS® tools are modified.
The experiences of State employees in Kansas and Washington and Medicaid enrollees in New Jersey, who were among the first to use CAHPS®, are being formally evaluated by the three centers involved in developing CAHPS®. Based on these assessments, evaluations from other sites, and other reports from users, CAHPS® will be further refined to improve the way information is presented to consumers. These studies will also assess how providing information on health plan quality affects the way consumers choose health plans.
CAHPS® has five essential characteristics that make it uniquely valuable to users. It is consumer-oriented; it is scientifically based and rigorously tested; it is easy to administer; it is widely applicable across populations and settings; and it is in the public domain.
CAHPS® surveys are being used by more than 20 States, 10 employer groups, the Medicare Program, the Federal Employees Health Benefits Program, a wide range of health plans, and a division of Ford Motor Company. In 1999, over 90 million Americans will receive information on health plans resulting from CAHPS®.
A second version of the CAHPS® questionnaire (2.0) is now available and a fully revised, comprehensive survey and reporting kit is now available (select to download). Now, AHRQ-sponsored researchers are studying ways to adapt CAHPS® to address a new need: information from patients on their experience with health care providers. This effort will add a critical new tool to the array of information that Americans have as they make their health care choices among increasingly diverse options.
In 1999, over 90 million Americans will have access to CAHPS® data to help them choose a health plan, including 39 million Medicare beneficiaries and 9 million Federal employees, retirees, and their family members covered under the Federal Employees Health Benefits Program.
CAHPS® information and questionnaires are available online: CAHPS® Fact sheet, CAHPS® Overview, and CAHPS® 2.0 Questionnaires (Download). The CAHPS® Survey and Reporting Kit may be obtained free of charge from the AHRQ Publications Clearinghouse at 1-800-358-9295. Electronic requests may be made to: ahrqpubs@ahrq.gov. Technical assistance in using the kit is available from the Survey Users Network telephone help line at 1-800-492-9261.
AHRQ Publication No. 00-P014
Replaces AHCPR Publication No. 99-P011
Current as of January 2000
Internet Citation:
From the Pipeline of Health Services Research—CAHPS®: The Story of the Consumer Assessment of Health Plans. Translating Research Into Practice Fact Sheet. AHRQ Publication No. 00-P014, January 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/cahptrip.htm
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