How CAHPS Surveys Measure Patient Experience

Jeff Brady: On behalf of the Agency for Healthcare Research and Quality, welcome to this podcast about the role of CAHPS surveys in assessing patient experience. I'm Rear Admiral Jeff Brady, Assistant Surgeon General, U.S. Public Health Service and director of AHRQ's Center for Quality Improvement and Patient Safety. The Agency's Consumer Assessment of Healthcare Providers and Systems, or CAHPS, program develops surveys that ask patients about their experiences with various aspects of the health care they've received. I'm here with Susan Edgman-Levitan, Researcher for the CAHPS program, and also the executive director of the Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital.

Susan, I’m delighted to be speaking with you today. You’ve been involved with the CAHPS program from the very beginning, right?

Susan Edgman-Levitan: Yes, that's right. It's been over 20 years, and I'm so proud of what we have accomplished and how it has benefited both patients and health care providers.

Jeff Brady: So let's start by talking about the purpose of CAHPS surveys, which is to measure patient experience. A lot of people still think that patient experience is the same as patient satisfaction. Although they're related, it seems to me that they are two different ways of understanding care from the patient's perspective.

Susan Edgman-Levitan: I agree. I'm often asked about this, so I like to explain that patient experience covers the range of interactions that patients have with the health care system, including care from health plans as well as from doctors, nurses, and staff in hospitals and other facilities, and physician practices. When we talk about patient experience, we're talking about specific aspects of health care delivery that happen when patients seek and receive care, such as timely appointments, getting information, and good communication with their providers.

Jeff Brady: Exactly. Patient experience is a critical part of understanding the quality of care that patients receive. It's also an important part of delivering care that's patient-centered. Information about patient experience tells us whether patients are receiving care that is respectful of and responsive to their needs. As the U.S. Agency tasked with developing and disseminating scientific knowledge, tools, and data to improve the health care system, we consider patient experience to be an essential part of health care quality.

Susan Edgman-Levitan: Patient satisfaction, on the other hand, is about whether a patient's expectations were met. Two people who receive the exact same care can give different satisfaction ratings because of their different expectations for how that care was supposed to be delivered. Measuring patient satisfaction tells you how patients feel about their care, but not what actually happened. This makes it hard for providers to know what, if anything, they should be doing differently.

Jeff Brady: That's a great point. When we ask about patient experience in a CAHPS survey, we're trying to find out from patients whether something that should happen in a health care setting—something such as clear communication with a provider—actually did happen or how often it happened. Let's talk about how CAHPS surveys get that kind of information.

Susan Edgman-Levitan: Well, when we started with the CAHPS Health Plan Survey, we established some important principles for CAHPS survey design. One is that the surveys focus on things that patients have told us are important to them; another is that we focus on topics for which patients are the best and often the only source of the information. We're not asking patients to evaluate the technical quality of their clinical care, since that information is better obtained from other sources. Instead, we're asking patients to tell us about things that only they can, like how often their health care providers are respectful and responsive; how often they get timely appointments and answers to medical questions; how well providers coordinate their care with specialists; and how well they are treated by staff.

Jeff Brady: One of the things that has really impressed me about the CAHPS surveys is that they are developed in a systematic and rigorous way, using well-established methods of survey science. I’ve seen the survey development process that the team follows to ensure that you are clear on the specific experiences that are most important to patients so that the survey gives you information that providers and facilities can use to improve their care.

Susan Edgman-Levitan: Yes, that's a very important part of our process. The surveys are all designed to provide information a health care organization can use to improve care. Because CAHPS survey questions focus on whether or not something specific happened in a health care setting, the results are easy to interpret. I have worked with many organizations that use CAHPS surveys to identify strengths and weaknesses in their performance, determine where they need to improve, and track their progress over time. We have also developed an improvement guide to help ambulatory care providers better understand how they can use CAHPS products to improve patient experience.

Jeff Brady: Susan, it has been a pleasure speaking with you today about CAHPS surveys and how they measure patient experience, and I thank you for all of the years you and the other members of the CAHPS Consortium have worked to make these surveys useful tools for health care providers and organizations. We at AHRQ are committed to ensuring that the CAHPS surveys and administration guidelines are based on sound science and reflect current health care practices, so they can continue to serve as reliable sources of information for health care improvement.

Susan Edgman-Levitan: It's been a pleasure! Thanks so much for having me!

Jeff Brady: Thank you for listening to this podcast from the Agency for Healthcare Research and Quality. You can download and listen to a variety of podcasts about CAHPS on our Web site at www.ahrq.gov/cahps. That’s www.a h r q.gov slash [/] c-a-h-p-s [www.ahrq.gov/cahps]. The Agency also offers free technical assistance for CAHPS surveys at 1-800-492-9261 or by email at cahps1@westat.com. That’s CAHPS, the number 1, at [@] w-e-s-t-a-t.com [cahps1@westat.com].