[Federal Register: July 31, 2003 (Volume 68, Number 147)]
[Notices]
[Page 44951-44953]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr31jy03-74]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Additional Hospital CAHPS[reg] (HCAHPS) Test Sites
AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.
ACTION: Notice of Request.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) in
partnership with the Centers for Medicare and Medicaid Services (CMS)
is soliciting volunteer sites for the additional testing of a draft
Hospital CAHPS (HCAHPS) instrument. The mutual goals of AHRQ and CMS
are to develop a standardized survey that is reliable and valid, that
will reside in the public domain, and that will make comparative non-
identifiable
[[Page 44952]]
information on hospital patients' perspectives on care widely
available. While there are many good survey tools available to
hospitals, there is currently no nationally used or universally
accepted survey instrument that allows comparisons across all
hospitals. To this end, at the request of CMS, AHRQ and the
CAHPS[reg]II grantees developed a draft HCAHPS instrument with input
from the various stakeholders in the industry. Initial testing of the
survey is being done as part of a CMS three-State pilot by hospitals in
Arizona, Maryland, and New York.
On June 27th, 2003, CMS published a Federal Register Notice (vol.
68, no. 124, pages 38346-38358) soliciting input into implementation
options and the draft HCAHPS survey. To take advantage of the input
received, AHRQ and CMS are interested in conducting additional testing
of the HCAHPS instrument, sampling and data collection processes to
assess issues involved in survey implementation. To accomplish these
tasks we plan to conduct very quickly, additional testing at a limited
number of hospitals that volunteer to work with AHRQ and CMS. This
notice describes an opportunity for volunteering for additional testing
for refining the HCAHPS survey and the nature of the implementation
procedures. Most of this additional testing will occur between
September and December 2003.
This is a separate initiative from ``The Quality Initiative: A
Public Resource on Hospital Performance''. (For more information about
that initiative, please see the Supplemental Information section of
this notice).
Types of Studies To Be Conducted During Additional Testing
A. Survey Method Issues
The following are some examples of the type of Methodological
studies that AHRQ and CMS would like to conduct. These will be
finalized once we have received public input at the close of the
comment period for the June 27th Federal Register Notice.
1. Test of mode effects (mail versus telephone) within hospitals
using randomly assigned split samples. Because HCAHPS, when finally
implemented, may be fielded in by both mail and telephone it is
important to test and revise the instrument so that there is
comparability across these modes.
2. Test the effect of intervening stays in other facilities. A
proportion of patients will be discharged from the hospital in question
to another facility before they go home. It is important to test the
effect of intervening stays in other facilities on HCAHPS scores for
the acute care hospital from which the patient was sampled.
3. Psychometric analyses to evaluate the equivalence of English and
the Spanish HCAHPS forms.
4. Test the effect of lag time on HCAHPS scale scores. Due to
logistical delays in obtaining up-to-date discharge lists, there will
almost certainly be a lag between hospital discharge and survey
administration. Long time lags between discharge and survey
administration may bias survey responses. For example, time since
discharge may affect the survey scores because respondents' memories of
their experience degrade with time or because the composition of the
respondent pool changes with time (the less healthy patients may be
less likely to respond or can not respond because they are too ill or
have expired).
5. Test the effect on response rate of different survey materials,
taking into account incremental changes in cost. There is some evidence
in the survey research literature that response rate can be influenced
by the type of survey materials that are sent out. In general
impersonal materials from lower status sources will result in lower
response rates than personalized materials sent out by higher status
sources. However, personalized materials may cost more to produce.
6. Evaluate the covariation of HCAHPS scores with clinical
indicators of hospital performance, such as those required by CMS in
the 7th scope of work for Quality Improvement Organizations (QIOs)
i.e., see www.cms.gov for more information on QIOs and the 7th scope of
work statement. These analyses would constitute an expansion of the
construct validity analyses for HCAHPS scores in the CMS Pilot.
7. Evaluate HCAHPS instrument psychometrically including the
following characteristics:
[sbull] Quality of item responses (missing item rates, skip pattern
errors);
[sbull] Factors associated with item response rates;
[sbull] Factors associated with survey response rates;
[sbull] Construct validity of composites and ratings;
[sbull] Internal consistency;
[sbull] Hospital level reliability;
[sbull] Components of variance; and
[sbull] Case mix adjustment.
B. Implementation Issues
AHRQ and CMS also seek to study the processes for implementation of
HCAHPS. Topics include:
1. Sampling procedures that worked well or caused problems.
2. Survey operations procedures that worked well or caused
problems.
3. How easily or readily can HCAHPS be integrated into a hospital's
existing sampling and survey operations procedures.
Criteria for Additional Site Selection
While AHRQ and CMS would like to provide wide access to the survey
for testing, there are limited agency resources for coordinating the
testing and analysis of data. Therefore, it is necessary to seek
volunteer acute care sites that are able to provide the resources for
data collection using the HCAHPS survey, and agree to submit the data
to a central repository for analysis. Hospitals may volunteer to
participate in the testing program individually or in a group in
cooperation with a hospital association, chain or other coalition.
Potential testing sites will be selected that best meet the analytic
needs of the HCAHPS development effort. Thus, selection from among
potential candidate sites will be made using the practical criteria set
out below. Criteria for selection of the additional sites are designed
to achieve additional diversity in the characteristics of test sites,
obtain the most reliable and valid data possible, and to maximize the
use of resources allotted for this work.
The criteria for selection are as follows. The test site must:
1. Be able to pay the full cost of data collection and database
creation using specifications provided by AHRQ;
2. Be able to field the survey within the timeframe specified by
AHRQ to be determined at the time of selection (Most of the testing
will occur between September and December 2003, but additional testing
may be done in early 2004. Applicants should indicate their ability to
carry out the work during those periods in response to Information Item
12 below);
3. Employ a survey vendor with an established record of hospital
patient survey experience;
4. Be able to provide an adequate sample size to meet the needs of
analyses;
5. Be able to adapt survey implementation as requested by AHRQ, to
meet the needs of the experimental design; and
6. Be able to provide a person to coordinate the test site work
with AHRQ.
Selection of additional test sites will be determined at the sole
discretion of the AHRQ and CMS.
[[Page 44953]]
Information Requirements: To volunteer to participate as an
additional testing site, please provide the following information:
1. Volunteer site9s) name(s) and location(s).
2. Contact person information including name and title, address,
telephone number, fax number and e-mail address.
3. Coordinator for site data collection information (if different
from contact person) including name and title, address, telephone
number, fax number and e-mail address.
4. The following are examples of the types of studies that may be
useful. Additional ones may be identified as a result of the June 27th
Federal Register Notice. Please provide information about what types of
studies you will or will not be willing to participate in.
a. Test of mode effects (mail versus telephone).
b. Test the effect of intervening stays in other facilities.
c. Psychometric analyses to evaluate the equivalence of English and
Spanish HCAHPS forms.
d. Test the effect of lag time on HCAHPS scale scores.
e. Test the effect on response rate of different survey materials
(e.g., personalized cover letters), taking into account incremental
changes in cost.
f. Evaluate the covariation of HCAHPS scores with clinical
indicators of hospital performance.
g. Evaluate HCAHPS instrument psychometrically.
h. Sampling procedures that worked well or caused problems.
i. Survey operations procedures that worked well or caused
problems.
j. How easily or readily HCAHPS is integrated into a hospital's
existing sampling and survey operations procedures.
5. Number of hospitals proposed for inclusion in the testing.
6. Evidence that hospital(s) is/are willing to participate (i.e.,
acknowledgement or confirmation from CEO).
7. Average number of discharges per month from participating
hospitals, and the average number of discharges for each of the
following services: medical, surgical, and obstetrics.
8. Name of current surveys being used in the site and modes of
administration of each survey used.
9. Name of current survey vendors working with the site(s).
10. Name of survey vendor who has the largest share of the hospital
market in which the volunteer facility, organization or association
operates.
11. Statement or affidavit indicating authorization to commit the
organization(s) to pay the specific estimated cost of sample selection,
data collection, database preparation and coordination with AHRQ.
12. Current schedule for data collection of patient survey data, if
you have one.
13. Process and schedule for selecting a vendor for the proposed
testing or name of vendor already selected.
dates: Please submit requested information on or before September 2,
2003.
addresses: Submissions should include a brief cover letter and the
requested information about the potential site(s). They may be in the
form of an e-mail with attachments, or a letter, preferably with an
electronic file in a standard word processing format, (e.g., Microsoft
Word or Word Perfect) on a 3\1/2\ inch diskette. E-mail submissions are
preferred and will be acknowledged upon receipt.
E-mail Responses to this request should be submitted to: hospital-
cahps@ahrq.gov. Written or faxed responses should be submitted to:
Charles Darby, Agency for Healthcare Research and Quality, Center
for Quality Improvement @ Patient Safety, 540 Gaither Road, Rockville,
MD 20850. Phone: (301) 427-1324; Fax: (301) 427-1341.
In order to facilitate handling of submissions, please include all
requested information about the candidate facilities. Please do not use
acronyms. Electronic submissions are strongly encouraged.
for further information contact: Charles Darby, Center for Quality
Improvement and Patient Safety, Agency for Healthcare Research and
Quality; Phone: (301) 427-1324; Fax: (301) 427-1341; E-mail
cdarby@ahrq.gov.
supplementary information: The Agency for Healthcare Research and
Quality (AHRQ) has been a leading proponent and supporter of the
development of instruments for measuring patient experiences within the
healhcare system of the United States. Through prior CAHPS[reg] patient
survey development efforts, AHRQ has been able to provide valuable
information to consumers and purchasers alike. The CAHPS survey for
health plans is widely accepted as an industry standard. Therefore, as
the research partner of CMS, AHRQ is charged with the development of a
hospital patient experience of care instrument as well as the
development of reporting strategies to maximize the utility of the
survey results. In an effort to provide a firm foundation of evidence-
based research for the HCAHPS instrument, the AHRQ is requesting
voluntary participation from acute care facilities as potential sites
for additional field-testing of the draft HCAHPS survey instrument to
provide analytic data that will complement the results of the pilot
testing done by QIOs for CMS.
Once HCAHPS is finalized, it will be made available to ``The
Quality Initiative: A Public Resource on Hospital Performance'', which
is a public/private partnership that includes the major hospital
associations, government, consumer groups, measurement and accrediting
bodies, and other stakeholders interested in reporting on hospital
quality. In the first phase of the partnership (which has already
begun), hospitals are voluntarily reporting the results of their
performance on ten clinical quality measures for three medical
conditions: acute myocardial infarction, heart failure, and pneumonia.
HCAHPS reporting will comprise the second phase of the effort.
For more information or to participate in the Quality Initiative
please visit http://www.aha.org under ``Quality and Patient Safety,
Quality Initiative,'' or at http://www.fah.org, under ``Issues/
Advisories,'' or at http://www.aamc.org by going to ``Government
Affairs,'' ``Teaching Hospitals'' and then ``Quality.''
Dated: July 24, 2003.
Carolyn M. Clancy,
Director.
[FR Doc. 03-19462 Filed 7-30-03; 8:45 am]
BILLING CODE 4160-90-M