This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders. There was some agreement on the value of these reports, but areas for improvement were noted.
[Show abstract][Hide abstract] ABSTRACT: The quality of medical care provided to individuals for work-related illnesses or injuries is important not only to employers and state programs, but also to the workers receiving the care. Workers' confidence in and satisfaction with workers' compensation care will influence their attitudes about the quality of the coverage offered by their employers as well as the performance of the larger workers' compensation system. In this context, it is important for providers, employers, and state officials to have information about the experiences that individuals had with workers' compensation medical care and their judgments about the quality of that care. Feedback from consumers about the quality of their health care complements other measures of the technical quality of clinical care. For example, substantial work has been done on the development of indicators defining appropriate practices for surgical procedures, use of prescription medications for specific health conditions, or management of a chronic disease such as diabetes. However, all of these clinical procedures could be performed perfectly while still leaving the patient unsatisfied, if the provider has not effectively engaged the patient in the care process and provided the care in a prompt and respectful manner. This paper explores the potential applicability of one health care survey and reporting system to worker's compensation medical care. This system is the Consumer Assessment of Health Plans (CAHPS®), which was developed by a consortium of research organizations in collaboration with the federal Agency for Healthcare Research and Quality (AHRQ, previously named the Agency for Health Care Policy and Research) (Crofton, et al., 1999). CAHPS has been used across the country by large employers, Medicare, Medicaid programs, states as employers, and other sponsors to obtain information from their constituencies about their experiences with health insurance plans and the health care and related services they received. The National Committee for Quality Assurance also uses CAHPS in its accreditation of managed care health plans. The CAHPS survey and reporting methods, which have been developed and tested over many years, could be a useful resource for application to the worker's compensation environment. OVERVIEW OF CAHPS®
[Show abstract][Hide abstract] ABSTRACT: Children enrolled in Medicaid have disproportionately high emergency department (ED) visit rates. Despite the growing importance of patient reported quality-of-care assessments, little is known about the association between parent-reported quality of primary care and ED utilization for these high-risk children. Our goal was to determine the association between parent-reported primary care quality and subsequent ED utilization for children in Medicaid.
We studied a retrospective cohort of children enrolled in Wisconsin Medicaid. Parents of children sampled during fall 2002 and fall 2004 completed Consumer Assessment of Healthcare Providers and Systems surveys assessing their child's primary care quality in 3 domains: family centeredness, timeliness, and realized access. Primary outcomes were the rates of subsequent nonurgent and urgent ED visits, extracted from claims data for the year after survey completion. Negative binomial regression was used to determine the association between the domains of care and ED utilization.
A total of 5468 children were included. High-quality family centeredness was associated with a 27% (95% confidence interval [95% CI] 11%-40%) lower nonurgent ED visit rate, but no lowering of the urgent visit rate. High-quality timeliness was associated with 18% (95% CI, 3%-31%) lower nonurgent and 18% (95% CI, 1%-33%) lower urgent visit rates. High-quality realized access was associated with a 27% (95% CI, 8%-43%) lower nonurgent visit rate and a 33% (95% CI, 14%-48%) lower urgent visit rate.
Parent-reported high-quality timeliness, family centeredness, and realized access for a publicly insured child are associated with lower nonurgent ED, with high-quality timeliness and realized access associated with lower urgent ED utilization.
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