Experiences of Care Among Medicare Beneficiaries With ESRD: Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results

Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, United Kingdom.
American Journal of Kidney Diseases (Impact Factor: 5.9). 11/2012; 61(3). DOI: 10.1053/j.ajkd.2012.10.009
Source: PubMed


BACKGROUND: Patients with end-stage renal disease (ESRD) have special health needs; little is known about their care experiences. STUDY DESIGN: Secondary analysis of 2009-2010 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) data, using representative random samples of Medicare beneficiaries. Description of Medicare beneficiaries with ESRD and investigation of differences in patient experiences by sociodemographic characteristics and coverage type. SETTING & PARTICIPANTS: Data were collected from 823,564 Medicare beneficiaries (3,794 with ESRD) as part of the Medicare CAHPS survey, administered by mail with telephone follow-up of nonrespondents. PREDICTOR: ESRD status, age, education, self-reported general and mental health status, race/ethnicity, sex, Medicare coverage type, state of residence, and other demographic measures. OUTCOMES: 6 composite measures of patient experience in 4 care domains (access to care, physician communication, customer service, and access to prescription drugs and drug information) and 4 ratings (overall care, personal physician, specialist physician, and prescription drug plan). RESULTS: Patients with ESRD reported better care experiences than non-ESRD beneficiaries for 7 of 10 measures (P < 0.05) after adjustment for patient characteristics, geography, and coverage type, although to only a small extent (adjusted mean difference, <3 points [scale, 0-100]). Black patients with ESRD and less educated patients were more likely than other patients with ESRD to report poor experiences. LIMITATIONS: Inability to distinguish patient experiences of care for different treatment modalities. CONCLUSIONS: On average, beneficiaries with ESRD report patient experiences that are at least as positive as non-ESRD beneficiaries. However, black and less educated patients with ESRD reported worse experiences than other ESRD patients. Stratified reporting of patient experience by race/ethnicity or education in patients with ESRD can be used to monitor this disparity. Physician choice and confidence and trust in physicians may be particularly important for patients with ESRD.

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    • "Increased satisfaction is seen in patients with chronic conditions that require more intense management. Using the CAHPS survey and similar analytical methods, it was demonstrated that patients with end stage renal disease experience greater satisfaction and better experiences with care [25]. Increased attentiveness is evident in our study by the self-reported, unadjusted increased number of self-reported discussions around nutrition, exercise and medical checks (e.g. "
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    ABSTRACT: Background Obese, older adults often have multiple chronic conditions resulting in multiple health care encounters. However, their satisfaction and experiences with care are not well understood. The objective of this study was to examine the independent impact of obesity on patient satisfaction and experiences with care in adults 65 years of age and older with Medigap insurance. Methods Surveys were mailed to 53,286 randomly chosen adults with an AARP® Medicare Supplement Insurance Plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) in 10 states. Following adjustment for non-response bias, multivariate regression modeling was used to adjust for demographic, socioeconomic and health status differences to estimate the independent impact of weight on satisfaction and experiences with care. Outcome variables included four global and four composite measures of satisfaction and experiences with care. Results 21.4% of the respondents were obese. Relative to normal weight, obesity was significantly associated with higher patient satisfaction and better experiences with care in seven of the eight ratings measured. Conclusions Obese individuals were more satisfied and had better experiences with care. Obese individuals had more office visits and discussions about nutrition, exercise and medical checks. This may have led to increased attentiveness to care, explaining the increase in satisfaction and better experiences with care. Given the high level of satisfaction and experiences with care in older, obese adults, opportunities exist for clinicians to address weight concerns in this population.
    Full-text · Article · May 2014 · BMC Health Services Research

  • No preview · Article · Mar 2013 · American Journal of Kidney Diseases
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    ABSTRACT: Background and objectives: The US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients. Design, setting, participants, & measurements: Data were drawn from the Adelphi CKD Disease Specific Program (a retrospective, cross-sectional survey of nephrologists and patients). Selected United States-based nephrologists treating patients receiving hemodialysis completed patient record forms and provided information on their dialysis center. Patients (n=404) completed the CAHPS-ICH survey (comprising 58 questions) providing six scores for the assessment of patient experience of care. CAHPS-ICH item-scale convergence, discrimination, and reliability were evaluated for multi-item scales. Floor and ceiling effects were estimated for all six scores. Patient (demographics, dialysis history, vascular access method) and facility characteristics (size, ratio of patients-to-physicians, nurses, and technicians) associated with the CAHPS-ICH scores were also evaluated. Results: Item-scale correlations and internal consistency reliability estimates provided support for the nephrologists' communication (range, 0.16-0.71; α=0.81) and quality of care (range, 0.16-0.76; α=0.90) composites. However, the patient information composite had low internal consistency reliability (α=0.55). Provider-to-patient ratios (range, 2.37 for facilities with >36 patients per physician to 2.8 for those with <8 patients per physician) and time spent in the waiting room (3.44 for >15 minutes of waiting time to 3.75 for 5 to <10 minutes) were characteristics most consistently related to patients' perceptions of dialysis care. Conclusions: CAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.
    Full-text · Article · May 2014 · Clinical Journal of the American Society of Nephrology
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