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Measuring Satisfaction in Nursing Homes

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					Measuring Satisfaction in Nursing Homes

The Consumer Assessment of Healthcare Providers & Systems (CAHPS)


Sponsors
– Agency for Healthcare Research & Quality – Centers for Medicare & Medicaid Services



Research Partners
– RAND Corporation – Department of Health Care Policy, Harvard Medical School & Center for Survey Research at University of Massachusetts Boston – Research Triangle Institute/ American Institutes of Research – Westat

Nursing Home Surveys


Resident
– Long stay resident - interview format – Post-acute resident - mail format



Family
– As a customer/decision maker – Focuses on families of long stayers – Telephone/mail format

Instrument Development

     

Literature review Consultation with experts Focus groups Identification of potential domains Quality of care item development Cognitive testing – 5 rounds Decision to merge quality of life
– Selection of quality of life items – Cognitive testing – 2 rounds

Systematic Testing of Question Formats and Response Options


Reporting items
– Day-based frequency reports
• Categorical number of days • Every day, most days, some days, no days

– Frequency reports with adverbs – always to never – Yes/no


Rating items
– Numbered ratings – 0 – 10 scale – Adjective scales - excellent to poor – Comparative evaluation
• Needs no improvement, needs a little improvement, needs a lot of improvement • Okay, Could be a little better, Could be a lot better



Time frame
– One week – One day – Non-specific present

Field Test Phase
12 nursing homes, 1 pretest home  652 surveys


– 424 interviews – 128 mail responses

Long Stay Interview Sample


Eligibility criteria from MDS items
– No guardian or other legal oversight – Not severely impaired in skills for daily decision making – Not comatose – In nursing home at least 30 days – No discharge planned



57% estimated eligible for interview
– Estimate could increase to 67% – Severely impaired eliminates 18% and guardian 13%

Interview Participation
 

69% of eligible assigned sample interviewed Interviewers rated respondent understanding
– 66% “always understood” – 30% “sometimes understood”



Reasons for 31% non-interview
– – – – – – 12% unable to answer 3 questions in a row 7% unresponsive 6% refused 3% ill 2% hearing problems 1% other

Interviewed and Not Interviewed by Cognitive Performance Scale Level
300 250 200 150 100 50 0 cps=0 cps=1 cps=2 cps=3 cps=4 Not interviewed Interviewed

Interview Summary


57-67% of NH residents estimated eligible  69% of eligible residents interviewed  16 – 24 minutes estimated time to complete
– 83% of interviews took 20 minutes or less


$57 estimated cost per interview with professional interviewers

Mail Survey Sample


Short stay residents discharged within last 2 months  Eligibility criteria
– – – – Must have been in NH at least 5 days Must not have been in longer than 90 days No legal guardian or other legal oversight Not severely impaired in skills for daily decision making – Not dead or discharged to another NH


62% estimated eligible

Completed Questionnaires by Cognitive Performance Scale Level
140 120 100 80 60 40 20 0 cps=0 cps=1 cps=2 cps=3 cps=4 Not returned Survey returned

Survey Cost and Completion Rates


52% Overall
– 57% Nursing homes with 2 mailings – 43% nursing homes with 1 follow-up mailing



$16.25 per completed survey

5 Composite Measures
Scale Environment Care Communicati on & Respect Autonomy Activities Number of items 9 5 3 Internal Consistency 0.73 0.77 0.86

3
2

0.56
0.64

NH Level Reliability of Scales
Scales F Group Reliability Total nonmissing N Average N per NH N needed to reach 0.7 reliability

Environment

2.06

0.51

566

43.5

95.8

Care

2.59

0.61

558

42.9

63.0

Communication & Respect

2.36

0.58

555

42.7

73.2

Autonomy

1.72

0.42

556

42.8

138.6

Activities

2.85

0.65

532

40.9

51.6

Next Steps


Long Stay Resident Interview Survey
– Refine identified questions – Beta test with enhanced sample

 

Short Stay Mail Survey
– Re-field with larger sample

Family Survey
– Complete instrument development – Conduct initial field test

Conclusions


Eliminating severely impaired in skills for daily decision making and terminating if respondent cannot answer 3 questions in a row appears to work  Survey has appropriate length, questions work well, & had few refusals  May need multiple rounds or rolling samples to obtain adequate numbers for reliable composite measures  We welcome opportunity for new partnerships


				
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posted:11/9/2009
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