pS Consumer Assessment Health Plan Survey: CAHPS® Gathering patient experiences Oktober 2004 Barbara Vriens

pS Outline Instruments Construction Response Validation Key findings Hospitals and Diabetics Questions

pS Instruments (1): 2 Markets

pS Instruments (2): CAHPS Consumer Assessment of Health Plans Survey, developed by the Agency for Healthcare Research and Quality (AHRQ) in the U.S. A CAHPS-questionnaire captures the experiences of patients with received care and experiences of customers with a health plan.

pS Instruments (3): developed june 2003 – june 2004 Healthcare market Diabetics CAHPS-NL Hospital CAHPS-NL Health insurance market Commercial CAHPS-NL

pS Instruments (4): Items ( experience, not satisfaction) Getting needed care Getting care quickly Courteous, respectful and helpful office staff How well doctors & nurses communicate Health plans customer service, information and paperwork Global ratings (nurses, doctors, hospital, health plan) Patient/Consumer demographics Quality of care (diabetic, i.e. group- cahps)

pS Construction (1): proces CAHPS ® : Adult Commercial Questionnaire Adult MedicAid Managed Care Adult MedicAid Fee-for-Service Supplement Hospital CAHPS ® Selection of questions Translation US-Dutch And Dutch-US Choice of best translation Translate and add extra questions

pS Construction (2): proces Extra questions were added in the following CAHPS: Commercial CAHPS-NL: questions about language spoken in order to see differences in non-Dutch origin and Dutch origin; Diabetics CAHPS-NL: QUOTE*-questions about specific diabetic-care (formulated in CAHPS structure). * QUality Of care Through the patients’ Eyes. The Quote-Diabetes is developed by Nivel, 2000.

pS Response Number of addressesCrude response Commercial CAHPS-NL97756% Diabetic CAHPS-NL (Amsterdam) 98357% Hospital CAHPS-NL (2 hospitals) %

pS Validation: Key findings Commercial CAHPS-NL Compares health insurance companies on Getting needed care Getting care quickly Courteous, respectful and helpful office staff How well doctors & nurses communicate Health plans customer service, information and paperwork Global ratings (nurses, doctors, hospital, health plan) Patient/Consumer demographics The translated questionnaire is found to be a useful instrument in the context of the Dutch healthcare system; A few questions should be adjusted to improve the questionnaire; Overall the new instrument was found to be valid and reliable.

pS Validation: Key findings Hospital CAHPS-NL Seven factors relating to patient hospital experience were constructed: communication with doctor communication with nurses discharge information communication about medication pain control physical environment nursing services Communication with nurses had the strongest relationship with the global ratings for nurses and hospital and likelihood of recommending the hospital; Differences between the two hospitals can be pointed out as differences between quality Overall the new instrument was found to be valid and reliable; The findings mirrored the results in the US and surveys in Dutch hospitals.

pS Experience hospital A and B (ill and healthy)

pS Experience (hospital A and B)

pS Population (hospital A and B)

pS New Medication and discharge experiences Both hospitals have low outcome on new medication Purpose and name of the medicine Co-medication Side-effects Allergic reactions Both hospitals have low outcome on discharge information Information how to behave Information about taking notice

pS Validation: Key findings Diabetes CAHPS-NL For a few aspects the findings mirrored other studies. There are limited studies available to compare; Ratings of patients have a relationship with the period in witch care was received (check of HbA1c, Cholesterol, blood pressure, feet); A few questions should be adjusted; Overall the new instrument was found to be a valid and reliable basis for further development.

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pS Show respectListening carefullyExplain thingsHave enough time Total

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pS HbA1cCAHPSDiabcare Lower dan 979%87% 9 or higher21%13% Blood pressureCAHPSDiabcare Lower dan 9074%80% 90 or higher26%20% Lower dan 14047%45% 140 or higher53%55% Outcome

pS CAHPSDiabcare Eye controle70%68% Feet controle60%65% Urine controle60%82% Blood pressure90%92% HbA1c87% Process

pS parameterprocesUitkomstenPunten HbA1c (Long term suger) 93% of the patients had their HbA1c measured in the last 12 months 55% < 8% ≤ 21% ≥ 9,5% 5 10 Lipid profile85% of the patients had their lipid profile measured in the last 12 months 63% heeft LDL ≤ 130 mg/dl 20 Risc profileOf 90% of the patients the risk profile is known based on blood pressure, Hba1c and lipid profile Improvement of 10% 40

pS parameterprocesuitkomstbonus Patient experience90% is informed about HbA1c, blood pressure and life style 80% knows their own level of HbA1c, blood pressure and reproduces life style advise 20 afstemming (interaction between professionals) 80% gets uniform information from the different health providers of goals to achieve 20

pS Questions?

pS Organisation of mailings 1. Selection of patiënts/customers and corresponding names and adressess 2. Making mailpack 3. Send mailpacks and reminders 4. Monitoring response (telephone and mail) 5. Scanning Question- naires

pS 1.Selectie mailbestand aSteekproeven (doelgroepbepaling) Algemeen (1000, a-select, jaar) Diabetes (1000, Amsterdam, jaar) Ziekenhuizen (korter dan 3 mnd geleden ontslagen, jaar) Lucas Andreas (1000, aangeleverd door het ziekenhuis) Flevo(1000, aangeleverd door het ziekenhuis) bKoppeling NAW cControles Actualiteit (M&V) Non-mailing list (M&V) Maximaal 1 vragenlijst per verzekerde

pS 2.Samenstelling mailpack Samenwerkingen vaststellen (NDF, NPCF) Begeleidende brief (inhoud, ondertekening) Ontwerp briefpapier, enveloppen en postkaart Bestellen en drukken briefpapier etc. Opmaak vragenlijsten (Algemeen, Diabetes, Ziekenhuizen) Incl. enquêtenummers Printen vragenlijst (gepersonaliseerd met code) Printen brieven

pS 3.Verzending vragenlijsten door MailStreet Testen verzending 1 Couverteren Verwijderen overleden verzekerden Verzending 1: brief, vragenlijst, antw.envelop Printen postkaarten Verwijderen overleden verzekerden Verzending 2: postkaart (na 1 week) Verwijderen respondenten Printen vragenlijsten Verwijderen overleden verzekerden Verzending 3: brief en vragenlijst (na 3 weken) Verwijderen respondenten Printen vragenlijsten Verwijderen overleden verzekerden Verzending 4: brief (na 2 weken) Verzending 1 Algemeen en Diabetes Verzending 3 Verzending 4 6 weken Ziekenhuizen Verzending 2

pS 4.Monitoring respons Retour enveloppen bij Agis Dagelijks aantal respondenten bij mailstret Verzending van reminders Registratie telefonische vragen en verzoeken Beantwoorden vragen en verzoeken Follow up Rapportage

pS 5.Scanning questionnaires

pS Juridische haken en ogen Medische selectie Wetenschappelijke haalbaarheidsstudie, goed verzekeraarschap Dataselections for DBC’s and FKG-groups already exist Privacy Protocol Privacy wordt gewaarborgd doordat alleen MailStreet de individuele resultaten ziet met NAW en verzekerde nummer erbij. Zie sleutelbestand

pS Aanmaken sleutelbestand Verzekerde Enquête nummer Verzekerde NAW Geslacht Geboorte nummer datum Verzekerde NAW Geslacht Enquête nummer nummer Agis Notaris MailStreet Verzekerde “Externe nummer gegevens“ Enquête Enquête Verzekerde “ Ext.Gegevens” nummer resultaten nummer Koppelbureau Enquête nummer resultaten Enquête Enquête “ Externe nummer resultaten gegevens”

pS Communicatie Intern Afstemming inkoopteams Mailprocedure Direct betrokkenen informeren Extern Steun van belangenorganisaties Medewerking relaties (zorgverleners) Voorlichting aan verzekerden (respondenten) Voorlichting aan pers

pS Patiëntenervaringen Ziekenhuis Formule en deskundigheid in huis of toegankelijk voor Agis Database eigendom van Agis Tevredenheid communicatie Tevredenheid zorg Tevredenheid specialistische zorg Tevredenheid toegang

pS Patiëntenervaringen diabeteszorg Formule en deskundigheid in huis of toegankelijk voor Agis Database eigendom van Agis Diabeteszorg algemeen58% goed of hoger Diabetesvragen beantwoord56% Toegang acute vraag46% Uitleg labresultaten50% Respect zorgverlener70% internist, diabetesverpleegkundige, diëtist, huisarts