Paul D Cleary

Yale University | YU · School of Public Health

Background: Data from surveys of patient care experiences are a cornerstone of public reporting and pay-for-performance initiatives. Recently, increasing concerns have been raised about survey response rates and how to promote equity by ensuring that responses represent the perspectives of all patients. Objective: Review evidence on survey admin...

Background: Hospitals may provide less positive patient experiences for older than younger patients. Methods: We used 2019 HCAHPS data from 4358 hospitals to compare patient-mix adjusted HCAHPS Survey scores for 19 experience of care items for patients ages 75+ versus 55-74 years and tested for interactions of age group with patient and hospital...

The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys collect standardized information about patient experiences of care from nationally representative samples of people with Medicare to support consumers’ enrollment choices and enable the Centers for Medicare & Medicaid Services to monitor care quality and incentivi...

Background The most widely used surveys for assessing patient health care experiences in the U.S. are the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies examining the associations of language and ethnicity with responses to CAHPS surveys have yielded inconsistent findings. More research is needed to assess the effe...

Background: The Agency for Healthcare Research and Quality held a research meeting on using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data for quality improvement (QI) and evaluating such efforts. Topics covered.: Meeting addressed: 1)What has been learned about organizational factors/environment needed to improve patient...

Background: To compare serious illness programs (SIPs) using recently developed patient experience measures, adjustment must be made for patient characteristics not under control of the programs. Objectives: To develop a case-mix adjustment model to enable fair comparison of patient experience between SIPs by investigating the roles of patient char...

Background: There is a pressing need for standardized measures to assess the quality of home-based serious illness care. Currently, there are no validated quality measures that are specific to home-based serious illness programs (SIPs) and the unique needs of their patients. Objective: To develop and evaluate standardized survey-based measures of s...

Objective: The objective of this study was to compare results of using web-based and mail (postal) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data collection protocols. Research design: Patients who had been hospitalized in a New England Hospital were surveyed about their hospital experience. Patients who provided...

Background Describe and evaluate an implementation science network focused on HIV prevention and treatment in New England. Methods In 2014, we established a partnership among university researchers and community stakeholders to stimulate and support HIV-related implementation research. We solicited information from Network members through surveys,...

Background There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender...

Background Slow progress in quality improvement (QI) has prompted calls to identify new QI ideas. Leaders guiding these efforts are advised to use evidence-based tactics, or specific approaches to address a goal, to promote clinician and staff engagement in the generation and implementation of QI ideas, but little evidence about effective tactics e...

Background: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. Objective: To assess how PCP communication with their care team relates to patients'...

Background: Recognition that coordination among healthcare providers is associated with better quality of care and lower costs has increased interest in interventions designed to improve care coordination. One intervention is to add care coordination to nurses' role in a formal way. Little is known about effects of this approach, which tends to be...

We assess the association between survey layout and response rates (RRs) in the 2017 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems mail survey. Among 438 Medicare Advantage plans surveyed by six vendors, there was latitude in survey layout, and plans could add up to 12 supplemental items. Regression models predicted sur...

Objective To assess the effect of changing survey questions on plan‐level patient experience measures and ratings. Data Source 2015 Medicare Advantage CAHPS Survey respondents. Study Design Ninety three randomly selected beneficiaries in each of 40 MA plans received a revised (5.0) CAHPS survey; 38 832 beneficiaries received version 4.0. Linear m...

Improving performance often requires creative ideas in extreme work settings like health care. Frontline workers are promising sources of creative ideas. The authors assert that their job dissatisfaction is positively associated with creativity in health care settings because negative emotion spurs creativity when tied to engaging work and that cha...

Objective To examine the effect of changing the sampling and reference periods for the CAHPS® Clinician & Group Survey from 12 to 6 months. Data Sources/Study Setting Adult patients with a visit in the last 12 months to New England community health centers. Study Design We randomly assigned patients to receive a survey with either a 12‐ or 6‐mont...

Objective The objective of this study was to compare response rates, respondents' characteristics, and substantive results for CAHPS surveys administered using web and mail protocols. Data Sources Patients who had one or more primary care visits in the preceding 6 months. Study Design/Data Collection Methods Patients for whom primary care practic...

Background: Previous studies found lower hospitalization rates for enrollees in Medicare Advantage (MA) plans than for beneficiaries with Fee-For-Service (FFS) coverage. MA enrollment is increasing, especially for those newly eligible for Medicare, but little is known about how service use in FFS or MA differs for new beneficiaries. Objective: T...

Objective To evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. Data Source/Study Design Pooled cross‐sectional 2010‐2011 Hospital Compare data (10/1/10 and 10/1/11 archives) and the 2012 American Hospital Association Annual Survey. Data Extraction We used 71 indicators of structure, proce...

Objectives: Despite increasing research attention on public trust in health care systems, empirical evidence on this topic in the developing world is limited and inconclusive. This paper examines the level and determinants of public trust in the health care system in China. Methods: We used data from a survey conducted with a sample of 5347 adul...

Public trust in health care systems has been measured in many countries, but there have been few studies of the intercountry variability in trust, or the degree to which such variability is because of population or structural characteristics. We used data from the health care survey conducted by the International Social Survey Program from 2011 to...

Importance Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialis...

Background: Public health agencies suggest targeting "hotspots" to identify individuals with undetected HIV infection. However, definitions of hotspots vary. Little is known about how best to target mobile HIV testing resources. Methods: We conducted a computer-based tournament to compare the yield of 4 algorithms for mobile HIV testing. Over 18...

Background: Understanding the flow of patients through the continuum of HIV care is critical to determine how best to intervene so that the proportion of HIV-infected persons who are on antiretroviral treatment and virally suppressed is as large as possible. Methods: Using immunological and virological data from the Centers for Disease Control a...

Objective: To assess whether communication training for housestaff via role-playing exercises (1) is well-received and (2) improves patient experience scores in housestaff clinics. Methods: We conducted a pre-post study in which the housestaff for 3 adult hospital departments participated in communication trainingled by trained faculty in small...

Background: The Centers for Medicare & Medicaid Services (CMS) recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure to reduce COPD readmissions, it is unclear how COPD readmission rates are related to other measures of qualit...

In 2015 the Medicare Hospital Value-Based Purchasing (VBP) program paid hospitals $1.4 billion in performance-based incentives; 30 percent of a hospital's VBP Total Performance Score was based on performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of the patient experience of care. Hospitals receive pat...

In his seminal work on health care quality, Avedis Donabedian noted that patient satisfaction was a key indicator of health care quality, and in the 1970s and 1980s a great deal of research explored the determinants of patient satisfaction. Subsequently, attention shifted toward assessing care experiences, and there is now a large body of evidence...

Objective: To examine the relationship between physician advice to quit smoking and patient care experiences. Data source: The 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Study design: Fixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally...

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007...

Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types. Surveys from 4,822,960 adult inpatients discharged July 2007-June 2008 or July 2010-June 2011 from 3,541 U.S. hospitals. Linear mixed-effect regression models with fixed effects...

To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality. Medical Expenditure Panel Survey data (2000-2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006. We estimated Cox proportional hazards models with mortality as the...

Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessmen...

Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and trea...

Background: The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey....

Background: Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information....

Aspects of the patient care experience, despite being central to quality care, are often problematic. In particular, patients frequently report problems with timeliness of care. As yet, research offers little insight on setting characteristics that contribute to patients' experience of timely care. The aims of this study were to assess the relation...

To examine how different response scales, methods of survey administration, and survey format affect responses to the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Clinician and Group (CG-CAHPS) survey. A total of 6,500 patients from a university health center were randomly assigned to receive the following: standard 12-page mail...

There is widespread interest in assessing care coordination to improve overall care quality. We evaluated a five-item measure of care coordination included in the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey (n = 326,194 respondents, 46% response rate). This measure includes patient reports of whether their p...

In an informative article on the assessment of patient care experiences, Zimlichman, Rozenblum, and Millenson describe the evolving use of surveys that elicit patient reports about medical care experiences in Israel, a trend that parallels developments in the U.S. This commentary summarizes some of experiences in the U.S. that might inform the deve...

An exploratory study of mental health treatment of people with multiple sclerosis (MS) to identify hypotheses for future testing. We mailed surveys to 8750 MS patients in four geographically distributed MS Centers; 3384 completed the survey. We used a modified version of the Experience of Care and Health Outcome Survey™ to assess mental health prob...

To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not. Medicare Advantage (MA) Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys asked about care experiences. Survey completion dates were linked to Social Security Administration death records to identify enr...

We describe the incidence and types of medical errors in emergency departments (EDs) and assess the validity of a survey instrument that identifies systems factors contributing to errors in EDs. We conducted the National Emergency Department Safety Study in 62 urban EDs across 20 US states. We reviewed 9,821 medical records of ED patients with one...

: To develop and evaluate survey questions that assess processes of care relevant to Patient-Centered Medical Homes (PCMHs). : We convened expert panels, reviewed evidence on effective care practices and existing surveys, elicited broad public input, and conducted cognitive interviews and a field test to develop items relevant to PCMHs that could b...

: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Adult Visit Survey enables patients to report their experiences with outpatient medical offices. : To evaluate the factor structure and reliability of the CAHPS Clinician and Group (CG-CAHPS) Adult Visit Survey. : Data from 21,318 patients receiving care in 45...

: The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. : To evaluate the impact of collaborati...

Background: Little is known about whether health information technology (HIT) affects patient experiences with health care. Objective: To develop HIT questions that assess patients care experiences not evaluated by existing ambulatory Consumer Assessment of Health Plans and Systems (CAHPS) measures. Research design: We reviewed published artic...

Multilevel interventions, implemented at the individual, physician, clinic, health-care organization, and/or community level, increasingly are proposed and used in the belief that they will lead to more substantial and sustained changes in behaviors related to cancer prevention, detection, and treatment than would single-level interventions. It is...

The Functional Status Questionnaire (FSQ) originally was developed to allow the comprehensive and efficient assessment of physical, psychosocial, social, and role functioning in ambulatory patients. It is a self-administered survey that takes approximately 15 min to complete and can be scored to produce a one-page report for clinicians to use in th...

Little is known about how to use patient feedback to improve experiences of health care. The Veterans Health Administration (VA) conducts regular patient surveys that have indicated improved care experiences over the past decade. The goal of this study was to assess factors that were barriers to, or promoters of, efforts to improve care experiences...

Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analys...

To estimate the prevalence of concurrency (more than 1 sex partner overlapping in time), the attitudes/behaviors of those engaged in concurrency, length of relationship overlap, and the association between concurrency and human immunodeficiency virus (HIV) among South Africans aged 15 to 24 years. A cross-sectional, nationally representative, house...

To evaluate the extent to which parents of children with cancer are involved in decision making in the ways they prefer during the first year of treatment. We conducted a cross-sectional survey of 194 parents of children with cancer (response rate, 70%) in their first year of cancer treatment at the Dana-Farber Cancer Institute and Children's Hospi...

Both clinical guidelines and direct-to-consumer (DTC) advertising influence the use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the 2 strategies. To evaluate the effects of clinical guidelines and a targeted DTC...

To examine whether disparities in health care experiences of Medicare beneficiaries differ between managed care (Medicare Advantage [MA]) and traditional fee-for-service (FFS) Medicare. 132,937 MA and 201,444 FFS respondents to the 2007 Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) survey. We defined seven subgroup chara...