Julie A Brown

RAND Corporation, Santa Monica, California, United States

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Publications (22)68.33 Total impact

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    ABSTRACT: Background: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group adult survey (CG-CAHPS) includes 34 items used to monitor the quality of ambulatory care from the patient's perspective. CG-CAHPS includes items assessing access to care, provider communication, and courtesy and respect of office staff. Stakeholders have expressed concerns about the length of the CG-CAHPS survey. Objectives: This paper explores the impact on reliability and validity of the CAHPS domain scores of reducing the numbers of items used to assess the 3 core CG-CAHPS domains (Provider Communication, Access to Care, and Courteous and Helpful Office Staff). Research design: CG-CAHPS data reported here consist of 136,725 patients across 4 datasets including ambulatory clinics, patient-centered medical homes, and Accountable Care Organizations. Analyses are conducted in parallel across the 4 settings to allow evaluations across data source. Analyses: Multiple regression and ANOVA techniques were used to evaluate reliability for shorter sets of items. Site-level correlations with the overall rating of the provider were compared to evaluate the impact on validity. The change in practices' rank-ordering as a function of domain revision is also reported. Results: Findings suggest that the Provider Communication (6 items) and Access (5 items) domains can be reduced to as few as 2 items each and Office Staff (2 items) can be reduced to a single item without a substantial loss in reliability or content. Conclusions: The performance of several of the reduced-length options for CG-CAHPS domains closely matches the full versions and may be useful in health care settings where the full-length survey is impractical due to time or cost constraints.
    No preview · Article · Nov 2015 · Medical care
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    ABSTRACT: Surveys often spend substantial money on multiple mailings and telephone calls to ensure high overall response rates and adequate representation of hard-to-reach demographic subgroups. We examine the extent to which an additional mailing and additional sets of telephone calls are effective in attaining these goals across a variety of subgroups in a large, national multimode survey of Medicare beneficiaries. We also examine the relative data quality of the responses that come with each level of extra effort. We find that additional mailings appear more effective in some groups, while additional telephone calls appear more effective in others. Tailoring the fielding strategy differently by subgroup may improve response rates at a lower cost per complete than using the same fielding protocol for all potential respondents, although data quality is likely to decline with additional efforts in either mode.
    No preview · Article · Nov 2015 · Field Methods
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    ABSTRACT: 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 personal doctor discusses their medicines, has medical records and other relevant information, and is informed about care from specialists, and whether the patient gets help in managing care and timely follow-up on test results. A one-factor categorical confirmatory factor analytic model indicated that five items constituted a coherent scale. Estimated health-plan-level reliability was 0.70 at about 102 responses per plan. The composite had a strong unique association with the CAHPS global rating of health care, controlling for the CAHPS core composite scores. This measure can be used to evaluate relative plan performance and characteristics associated with better care coordination.
    Full-text · Article · Nov 2013 · Medical Care Research and Review
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    ABSTRACT: The recently enacted Patient Protection and Affordable Care Act makes collecting information on patients' health care experiences a national priority. The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey is the largest survey of Medicare beneficiaries about their care experiences. Each year, a nationally representative random sample of beneficiaries enrolled in Medicare Advantage plans receive a mail survey, followed by a telephone follow-up of nonrespondents. The mail survey lists the respondent's plan name at the beginning and repeats the plan name in several of the questions. However, some beneficiaries may not recognize their plan name, potentially affecting their level of engagement with the survey and, in turn, unit and item response rates. An alternative approach is to use a generic survey in which the plan name appears only once, on the back of the survey booklet. This manuscript reports the results of a 2010 experiment in which a random subsample of beneficiaries were mailed a generic survey. Differences in unit and item response rates, as well as evaluations of care experiences, between beneficiaries who received a generic survey and those who received a customized survey were compared. The use of a generic survey did not appear to affect either unit or item response rates, and did not appear to affect the ways in which beneficiaries evaluate various aspects of their care experiences. These results suggest that generic mail surveys may be preferable to customized surveys, especially since they entail lower printing and mailing costs.
    No preview · Article · Jun 2013 · Public Opinion Quarterly
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    ABSTRACT: BACKGROUND: A doctor's ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS(®)) Clinician and Group Survey is the standard for collecting and reporting information about patients' experiences of care in the USA. OBJECTIVE: To evaluate how well CAHPS(®) Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication. DATA SOURCES/STUDY SETTING: Eleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan. STUDY DESIGN: Data were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items. PRINCIPAL FINDINGS: CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients. CONCLUSIONS: CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients' perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor-patient communication and interactions.
    Full-text · Article · May 2013 · The patient
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    ABSTRACT: To produce reliable and informative health plan performance data by race/ethnicity for the Medicare beneficiary population and to consider appropriate presentation strategies. Patient experience data from the 2008–2009 Medicare Advantage (MA) and fee-for-service (FFS) CAHPS surveys and 2008–2009 HEDIS data (MA beneficiaries only). Mixed effects linear (and binomial) regression models estimated the reliability and statistical informativeness of CAHPS (HEDIS) measures. Seven CAHPS and seven HEDIS measures were reliable and informative for four racial/ethnic subgroups—Whites, Blacks, Hispanics, and Asian/Pacific Islanders—at sample sizes of 100 beneficiaries (200 for prescription drug plans). Although many plans lacked adequate sample size for reporting group-specific data, reportable plans contained a large majority of beneficiaries from each of the four racial/ethnic groups. Statistically reliable and valid information on health plan performance can be reported by race/ethnicity. Many beneficiaries may have difficulty understanding such reports, however, even with careful guidance. Thus, it is recommended that health plan performance data by subgroups be reported as supplemental data and only for plans meeting sample size requirements.
    No preview · Article · Apr 2013 · Health Services Research
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    ABSTRACT: This report describes the findings from a demonstration conducted by RAND with the Florida Medicaid program to test applications of Consumer Assessment of Health Plans Study (CAHPS) consumer reports in the Medicaid sector. In collaboration with the Florida Agency for Health Care Administration (AHCA), we designed both paper and computer-based report formats, which were tested in field applications in Volusia County, Florida. This demonstration was the first of RAND's CAHPS demonstrations. Results of this work have been applied in subsequent demonstrations with the New Jersey and Iowa Medicaid programs.
    Full-text · Article · Nov 2012
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    ABSTRACT: The HCAHPS Survey obtains hospital patients' experiences using four modes: Mail Only, Phone Only, Mixed (mail/phone follow-up), and Touch-Tone (push-button) Interactive Voice Response with option to transfer to live interviewer (TT-IVR/Phone). A new randomized experiment examines two less expensive modes: Web/Mail (mail invitation to participate by Web or request a mail survey) and Speech-Enabled IVR (SE-IVR/Phone; speaking to a voice recognition system; optional transfer to an interviewer). Web/Mail had a 12% response rate (vs. 32% for Mail Only and 33% for SE-IVR/Phone); Web/Mail respondents were more educated and less often Black than Mail Only respondents. SE-IVR/Phone respondents (who usually switched to an interviewer) were less often older than 75 years, more often English-preferring, and reported better care than Mail Only respondents. Concerns regarding inconsistencies across implementations, low adherence to primary modes, or low response rate may limit the applicability of the SE-IVR/Phone and Web/Mail modes in HCAHPS and similar standardized environments.
    No preview · Article · Nov 2012 · Medical Care Research and Review
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    ABSTRACT: : 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 be added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CG-CAHPS) 1.0 Survey. Surveys were tested using a 2-contact mail protocol in 10 adults and 33 pediatric practices (both private and community health centers) in Massachusetts. A total of 4875 completed surveys were received (overall response rate of 25%). : We calculated the rate of valid responses for each item. We conducted exploratory factor analyses and estimated item-to-total correlations, individual and site-level reliability, and correlations among proposed multi-item composites. : Ten items in 4 new domains (Comprehensiveness, Information, Self-Management Support, and Shared Decision-Making) and 4 items in 2 existing domains (Access and Coordination of Care) were selected to be supplemental items to be used in conjunction with the adult CG-CAHPS 1.0 Survey. For the child version, 4 items in each of 2 new domains (Information and Self-Management Support) and 5 items in existing domains (Access, Comprehensiveness-Prevention, Coordination of Care) were selected. : This study provides support for the reliability and validity of new items to supplement the CG-CAHPS 1.0 Survey to assess aspects of primary care that are important attributes of PCMHs.
    Full-text · Article · Nov 2012 · Medical care
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    ABSTRACT: : To complement a nursing home resident survey, the team developed a survey asking family members about their experiences with nursing homes. Although a family member does not receive care directly from a nursing home, their experiences at the nursing home and with staff can contribute to understanding nursing home quality. : To describe how the nursing home family member instrument was developed, refined, tested, and finalized. : The team developed a draft survey using information from a literature review, 12 focus groups with family members involved in choosing a nursing home for someone, review of nursing home surveys, and expert/stakeholder input. The survey went through 2 rounds of cognitive interviews (n=54) and revisions and was fielded in 15 nursing homes. Data from the pilot survey (n=885) were subjected to psychometric analyses to evaluate the measurement properties of items as well as the reliability and validity of the resulting composites. On the basis of these analyses and input from experts, the survey was finalized. : Focus groups and experts provided input into discerning important indicators of quality, although in some cases family members were not the best sources of information. Cognitive testing refined the survey and eliminated some of the proxy items. The field test analysis and input from experts eliminated 10 items. The final survey included 21 items organized into 4 composites. : This survey measures family members' experiences of nursing home care, and the results contribute to the understanding of quality of care in nursing homes.
    No preview · Article · Nov 2012 · Medical care
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    ABSTRACT: 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 articles and conducted focus groups and cognitive testing to develop survey questions. We collected data, using mail and the internet, from patients of 69 physicians receiving care at an academic medical center and 2 regional integrated delivery systems in late 2009 and 2010. We evaluated questions and scales about HIT using factor analysis, item-scale correlations, and reliability (internal consistency and physician-level) estimates. Results: We found support for 3 HIT composites: doctor use of computer (2 items), e-mail (2 items), and helpfulness of provider's website (4 items). Corrected item-scale correlations were 0.37 for the 2 doctor use of computer items and 0.71 for the 2 e-mail items, and ranged from 0.50 to 0.60 for the provider's website items. Cronbach α was high for e-mail (0.83) and provider's website (0.75), but only 0.54 for doctor use of computer. As few as 50 responses per physician would yield reliability of 0.70 for e-mail and provider's website. Two HIT composites, doctor use of computer (P<0.001) and provider's website (P = 0.02), were independent predictors of overall ratings of doctors. Conclusions: New CAHPS HIT items were identified that measure aspects of patient experiences not assessed by the CAHPS C&G 1.0 survey.
    Full-text · Article · Nov 2012 · Medical Care
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    ABSTRACT: : Consumer assessment of health care is an important metric for evaluating quality of care. These assessments can help purchasers, health plans, and providers deliver care that fits patients' needs. : To examine differences in reports and ratings of care delivered to adults and children and whether they vary by site. : This observational study compares adult and child experiences with care at a large west coast medical center and affiliated clinics and a large mid-western health plan using Consumer Assessment of Healthcare Providers and Systems Clinician & Group 1.0 Survey data. : Office staff helpfulness and courtesy was perceived more positively for adult than pediatric care in the west coast site. In contrast, more positive perceptions of pediatric care were observed in both sites for coordination of care, shared decision making, overall rating of the doctor, and willingness to recommend the doctor to family and friends. In addition, pediatric care was perceived more positively in the mid-west site for access to care, provider communication, and office staff helpfulness and courtesy. The differences between pediatric care and adult care were larger in the mid-western site than the west coast site. : There are significant differences in the perception of care for children and adults with care provided to children tending to be perceived more positively. Further research is needed to identify the reasons for these differences and provide more definitive information at sites throughout the United States.
    No preview · Article · Nov 2012 · Medical care
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    ABSTRACT: Using data from 335,249 Medicare beneficiaries who responded to the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, along with data from 22 cognitive interviews, we investigated the reliability and validity of an instrument designed to assess beneficiaries' experiences with their prescription drug plans. Composite measures derived from the instrument had acceptable internal consistency and sufficient plan-level reliability to inform consumer choice, quality improvement, and payor oversight. These measures were positively associated with members' overall rating of the plan and their willingness to recommend the plan. Moreover, each was independently useful in predicting beneficiaries' global ratings of their plan. This instrument can be an important tool for helping beneficiaries to choose a plan that best meets their needs.
    Full-text · Article · Feb 2009 · Health care financing review
  • Kimberly A Hepner · Julie A Brown · Ron D Hays
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    ABSTRACT: The medical group survey from the CAHPS (formerly Consumer Assessment of Health Plans Study) project, G-CAHPS, focuses on patient experiences in receiving care from their medical group practice. We compared mail and telephone responses to the G-CAHPS survey in a sample of 880 patients from four physician groups. Patients were randomly assigned to mode. Analyses included comparison of response rates, missing data, internal consistency reliability of six multi-item scales, and mean scores. A total of 537 phone completes and 343 mail completes were obtained (54% response rate). There were no significant differences in internal consistency by mode. In addition, there was only one significant mode difference in item and composite means by mode of administration after adjusting for case-mix differences. This study indicates that mail and telephone modes of data collection for the G-CAHPS survey produce similar results.
    No preview · Article · Jan 2006 · Evaluation & the Health Professions
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    Roger E Levine · Floyd J Fowler · Julie A Brown
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    ABSTRACT: To describe how cognitive testing results were used to inform the modification and selection of items for the Consumer Assessment of Health Providers and Systems (CAHPS) Hospital Survey pilot test instrument. Cognitive interviews were conducted on 31 subjects in two rounds of testing: in December 2002-January 2003 and in February 2003. In both rounds, interviews were conducted in northern California, southern California, Massachusetts, and North Carolina. A common protocol served as the basis for cognitive testing activities in each round. This protocol was modified to enable testing of the items as interviewer-administered and self-administered items and to allow members of each of three research teams to use their preferred cognitive research tools. Each research team independently summarized, documented, and reported their findings. Item-specific and general issues were noted. The results were reviewed and discussed by senior staff from each research team after each round of testing, to inform the acceptance, modification, or elimination of candidate items. Many candidate items required modification because respondents lacked the information required to answer them, respondents failed to understand them consistently, the items were not measuring the constructs they were intended to measure, the items were based on erroneous assumptions about what respondents wanted or experienced during their hospitalization, or the items were asking respondents to make distinctions that were too fine for them to make. Cognitive interviewing enabled the detection of these problems; an understanding of the etiology of the problem informed item revisions. However, for some constructs, the revisions proved to be inadequate. Accordingly, items could not be developed to provide acceptable measures of certain constructs such as shared decision making, coordination of care, and delays in the admissions process. Cognitive testing is the most direct way of finding out whether respondents understand questions consistently, have the information needed to answer the questions, and can use the response alternatives provided to describe their experiences or their opinions accurately. Many of the candidate questions failed to meet these standards. Cognitive testing only evaluates the way in which respondents understand and answer questions. Although it does not directly assess the validity of the answers, it is a reasonable premise that cognitive problems will seriously compromise validity and reliability.
    Full-text · Article · Jan 2006 · Health Services Research
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    ABSTRACT: While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored. Patients had a mean age of 81 years (range 75-93) and 67% were female while proxies had a mean age of 70 (range 42-87) and 49% were female. ICCs were 0.63 for the SF-12, 0.52 for the UI scale, and 0.29 for the FES. Proxies tended to understate patients' general health and incontinence concern, but overstate patients' concern about falling. Proxies who lived with patients and those who more often see patients more closely reflected patient FES scores compared to those who lived apart or those who saw patients less often. Internal consistency reliability of proxy responses was 0.62 for the SF-12, 0.86 for the I-QOL, and 0.93 for the FES. In addition, construct validity of the proxy FES scale was supported by greater proxy-perceived fear of falling for patients who received medical care after a fall during the past 12 months (p < .05). Caution should be exercised when using proxies as a source of information about older patients' health perceptions. Questions asking about proxies' views yield suboptimal agreement with patient responses. However, proxy scales of UI and fall concern are internally consistent and may provide valid independent information.
    Full-text · Article · Nov 2005 · Health and Quality of Life Outcomes
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    ABSTRACT: To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries. The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases. An experimental design was used, with new Medicaid cases randomly assigned to experimental or control groups. The experimental group received a CAHPS report along with the standard enrollment materials, and the control group did not. The HMO enrollment data were obtained from the state in June 1998, and evaluation survey data were collected from July to October 1998. No effects of CAHPS information on HMO choices were found for the total sample. Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores. The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores, on average, than did those in an equivalent control group. Health plan performance information can influence plan choices by Medicaid beneficiaries, but will do so only if they actually read it. These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices.
    Full-text · Article · Sep 2002 · Health Services Research
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    ABSTRACT: The focus of the literature review is consumer assessment of providers at the medical group level. The Internet provides access to a range of searchable databases. Without a search strategy, however, untold hours may be spent scouring different, sometimes overlapping bibliographies. For this reason, we devised a systematic search strategy to ensure a quality and comprehensive search. Time limits and other constraints on the search helped to combat diminishing returns. Thorough documentation is the best guarantee that references are not lost or unnecessarily duplicated. To maintain quality control in our literature review, we documented not only the reference of interest, but also any information about the search path that led to the reference. This helped to retrospectively analyze the comprehensiveness of our search and allows for the reproducibility of the search results. For each iteration of the literature search, we recorded the following information: (a) database searched, (b) key words and search option combinations, (c) specific organization or WWW site, (d) years used for the search, (e) number of returned references per search, and (f) number of selected references per search.
    Full-text · Article · Aug 2000
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    ABSTRACT: To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white). A random sample of patients receiving medical care from a physician group association concentrated on the West Coast was studied. A total of 7,093 English and Spanish language questionnaires were returned for an overall response rate of 59%. Five questions asking patients to rate communication by their health care providers were examined in this study. All five questions were administered with a 7-point response scale. We estimated the associations of satisfaction ratings with language (English vs Spanish) and ethnicity (white vs Latino) using ordinal logistic models, controlling for age and gender. Latinos responding in Spanish (Latino/Spanish) were significantly more dissatisfied compared with Latinos responding in English (Latino/English) and non-Latino whites responding in English (white) when asked about: (1) the medical staff listened to what they say (29% vs 17% vs 13% rated this "very poor," "poor," or "fair"; p <.01); (2) answers to their questions (27% vs 16% vs 12%; p <.01); (3) explanations about prescribed medications (22% vs 19% vs 14%; p <.01); (4) explanations about medical procedures and test results (36% vs 21% vs 17%; p <.01); and (5) reassurance and support from their doctors and the office staff (37% vs 23% vs 18%; p <.01). This study documents that Latino/Spanish respondents are significantly more dissatisfied with provider communication than Latino/English and white respondents. These results suggest Spanish-speaking Latinos may be at increased risk of lower quality of care and poor health outcomes. Efforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.
    Full-text · Article · Jul 1999 · Journal of General Internal Medicine
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    ABSTRACT: The authors describe the process used to develop and test survey items targeted to Medicaid consumers for the Consumer Assessment of Health Plans Study (CAHPS). In addition, the authors highlight the special challenges in locating and surveying Medicaid recipients and provide recommendations for increasing response rates. The RAND CAHPS team reviewed the literature and existing questionnaires to identify health care issues and concepts important to Medicaid consumers. Three focus groups and 66 one-on-one cognitive interviews were conducted to test the relevance of our concepts and items and to identify additional concepts important to Medicaid consumers. After the cognitive interviews, the CAHPS Medicaid consumer survey was field tested using a sample of 930 adults and children receiving both Medicaid and Aid to Families with Dependent Children in Los Angeles County and Oklahoma. To determine if one particular mode were preferable for surveying a Medicaid population, our field test sample was divided randomly into a telephone-mode sample, a mixed-mode sample, and a second telephone-mode sample with enhanced locating procedures. Before finalizing the CAHPS 1.0 surveys, the full CAHPS item set was subjected to a formal literacy review. The results of the focus groups and cognitive testing informed iterative versions of the list of concepts addressed by the Medicaid-targeted items. Concepts that were not relevant to Medicaid consumers or that consumers were unable to accurately attribute to a health plan were discarded. New concepts addressing important aspects of health care and the health care experience of Medicaid consumers were identified and added. Item wording and format were revised and refined based on the findings from focus groups, cognitive testing, the field test, and the formal literacy review. In the field test, the mixed-mode method achieved the best results with a 56% completion rate. The testing and formatting efforts described in this article, in combination with a formal literacy review, led to the development of a Medicaid questionnaire that measures the important health care experiences of Medicaid consumers in a format that is "respondent-friendly." Our recommendations for surveying Medicaid recipients can benefit any survey of a Medicaid population.
    No preview · Article · Apr 1999 · Medical Care

Publication Stats

607 Citations
68.33 Total Impact Points

Institutions

  • 1998-2013
    • RAND Corporation
      Santa Monica, California, United States
  • 2009
    • Brooks Rand
      Seattle, Washington, United States
  • 2006
    • American Institutes for Research
      Washington, Washington, D.C., United States
  • 2002
    • University of California, Los Angeles
      • Department of Medicine
      Los Ángeles, California, United States