Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Pilot ProjectObjective: The CAHPS Hospital Survey, also known as H-CAHPS or Hospital CAHPS, is the first publicly available standardized survey designed to gather information from adult inpatients about their experiences with hospital care and services. The CAHPS Hospital Survey was developed by the Agency for Healthcare Research and Quality (AHRQ) which after extensive field testing released a final 27-item version of the instrument was endorsed by the National Quality Forum for national use in early 2006. The purpose of this study is to investigate how health systems, to include the TMA, can modify the existing HCAHPS instrument in ways that preserve trend information and best place customized questions that are of unique MHS interest. Many hospitals throughout the U.S are just now facing this decision about whether and how to integrate the H-CAHPS core into their survey efforts either by adding legacy items onto the end of the core as prescribed by CMS or field two separate surveys. The results of this Center for Health Care Management Studies investigation was designed to provide important findings to TMA, AHRQ and the national hospital industry.
Results: This study accomplished 3 major goals: development of CAHPS-style supplemental items to be used in conjunction with the 27-item core, evaluation of the effects of question placement for new survey items on standard HCAHPS composites, and development of new composites from items in new content areas. The most significant finding in this study is that the additional TMA-specific survey items that were woven throughout the core of the test survey did not materially affect the quality of nor the actual scores of the standard H-CAHPS composites that are required by The Centers for Medicare and Medicaid Services (CMS) from all hospitals that they reimburse on a yearly basis. Because CMS requires hospitals to submit all survey items from the 27 item core, more extensive item level analysis may be needed if CMS were to consider allowing items to be integrated into the 27 item core. This finding may be of great interest to AHRQ and the health service industry, specifically survey vendors who work closely with the hospitals and the hospitals themselves. These findings are of great importance to survey vendors as a roadmap to follow for the methods required to establish the reliability and validity of modified HCAHPS instruments. Where other health systems adopt policy-specific items that differ significantly in form and format they will need to replicate the methods employed in this study to ensure that the instrument complements CAHPS principles.