Research on Improving Patient Experience

Since the introduction of the CAHPS survey, researchers have studied the feasibility and value of using these surveys to support efforts to improve patient experience in ambulatory care settings, hospitals, and other settings.

Improving Patient Experience With Ambulatory Care

Ongoing and recent studies are focused on the following topics.

Reporting Patient Experience Information to Internal Users

As part of a larger collaborative research study with NewYork Presbyterian (NYP) that is investigating the feasibility, value, and use of the CAHPS Narrative Elicitation Protocol in ambulatory care practices, CAHPS researchers on the Yale team are testing a new feedback report. The design and delivery of this report reflects the preferences and suggestions of practice administrators, medical directors, clinicians, and staff. The team will be evaluating the value and use of this report for quality improvement through a pre-post comparison of results from an all-staff survey and in-depth interviews with the practice leaders, medical directors, clinicians and staff.

Learn more: Implementing the New CAHPS Protocol for Obtaining Patient Comments About Their Care (Webcast). In this webcast about the pilot project with NewYork-Presbyterian, the speakers shared what they had learned about the characteristics of narrative feedback reporting strategies that are important to guiding improvement.

Also see: Providing Performance Feedback to Individual Physicians: Current Practice and Emerging Lessons. In a working paper, RAND researchers document what is known to date about reporting quality data back to physicians. This paper was based on a literature review as well as key informant interviews. Participating researchers included members of the CAHPS RAND Team. Published July 2006.

Assessing the Impact of Nurse Care Coordination

CAHPS researchers on the Yale team evaluated the impact of a nurse care coordinator program on patients' health and care experience, as well as staff interactions and work experiences. This study focused on a program implemented at 12 community health centers affiliated with Community Health Center, Inc. (CHC), a private, non-profit, health system that provides comprehensive primary care services in Connecticut. The research team used the CAHPS Clinician & Group Survey with the Patient-Centered Medical Home items and other supplemental items that ask about coordination of care to assess changes in patients' experiences of care.

Assessing the Use of Clinician & Group Survey Results in a Pay-for-Performance Program

Working with AltaMed Health Systems, a large Federally Qualified Health Center in California, CAHPS researchers on the RAND team are evaluating the use of shadow coaching under a pay-for-performance incentive tied to CAHPS Clinician & Group Survey measures. The goal of AltaMed's pay-for-performance incentive and coaching initiative is to improve physician-patient interactions and the performance of providers on their patient experience survey.

Use of CAHPS Surveys in Patient-Centered Medical Homes

Impact of PCMH Transformation on Patient Experience. CAHPS researchers on the RAND team conducted research with AltaMed, a large Federally Qualified Health Center in California, to identify the specific PCMH-related activities that may affect patient experiences, the successes and challenges involved in implementing these activities as they affect patient experience, and the usefulness of data from the CAHPS Clinician & Group (CG-CAHPS) Survey in this process. Learn more:

Quigley DD, Mendel PJ, Predmore ZS, et al. Use of CAHPS^® patient experience survey data as part of a patient-centered medical home quality improvement initiative. J Healthcare Leadership 2015 Jul 7;(7):41-54. doi: http://dx.doi.org/10.2147/JHL.S69963.
Quigley DD, Predmore ZS, Chen A, et al. Implementation and sequencing of practice transformation in urban practices with underserved patients. Qual Manag Health Care. 2017 Jan/Mar;26(1):7-14. doi: 10.1097/QMH.0000000000000118.
Quigley DD, Palimaru AI, Chen AY, et al.. Implementation of Practice Transformation: Patient experience according to practice leaders. Quality Management in Health Care. 2017 July/Sep;26 (3), 140-151. doi: 10.1097/QMH.0000000000000141.
Setodji CM, Quigley DD, Elliott MN, et al. Patient experiences with care differ with chronic care management in a federally qualified community health center. Population Health Management. 2017 Dec;20(6):442-448. doi: 10.1089/pop.2017.0003. Epub 2017 Apr 7.

Use of CAHPS PCMH Items during PCMH Transformation. CAHPS researchers on the RAND team interviewed leaders in 105 primary care practices sampled from across the US to learn how they used CAHPS Clinician & Group Survey data during the process of becoming medical homes.

Learn more: Quigley DD, Predmore ZS, Hays RH. Tools to Gauge Progress during Patient-Centered Medical Home Transformation. The American Journal of Accountable Care 2017. 5(4):e8-e18.

Estimating the Magnitude of Differences in Patient Experiences Scores

CAHPS researchers on the RAND team conducted a systematic literature review of 22 articles that involved approaches to assessing the magnitude of differences in patient experiences scores between providers. Their research identified three main ways to develop estimates. The findings have implications for how differences in patient experience scores are interpreted when organizations assess the effectiveness of quality improvement efforts or trends in performance.

Learn more: Quigley DD, Elliott MN, Setodji CM, et al. Quantifying Magnitude of Group-Level Differences in Patient Experiences with Health Care. Health Services Research 2018. 53(4): 3027-3051. doi: 10.1111/1475-6773.12828

Case Studies on Improving Patient Experience with Ambulatory Care

Improving Customer Service at Health Share of Oregon (PDF, 279 KB). This case study discusses the strategies implemented by Health Share of Oregon, a coordinated care organization serving Medicaid recipients, to ensure that its customer service staff understand and meet the needs of its members. Health Share of Oregon was selected for this case study because of its high scores on the "Health Plan Customer Service" composite measure in the CAHPS Health Plan Survey as well as its improvement in one of the two survey items. Published September 2016.

How Two Provider Groups Are Using the CAHPS^® Clinician & Group Survey for Quality Improvement (PDF, 3.45 MB). This issue brief shares the experiences of two provider groups using the 12-Month version of the CAHPS Clinician & Group Survey to improve the delivery of care. It summarizes presentations delivered on an AHRQ-sponsored Webcast on October 8, 2013.

Improving Customer Service and Access in a Surgical Practice (PDF, 998 KB). This case study by the research team at RAND describes a surgical practice's successful implementation of a six-step plan to improve customer service and access for its patients. Published August 2011.

Improving Performance for Health Plan Customer Service (PDF, 1.2 MB). This case study by the research team at RAND focuses on the successful quality improvement methods employed by a health plan to improve customer service for its members. August 2007.

Improving Patient Experience With Hospital Care

Assessing Efforts to Improve Pediatric Inpatient Care using Child HCAHPS

The RAND CAHPS team has partnered with UCLA Mattel Children’s Hospital to examine the use and value of Child HCAHPS data for improving pediatric inpatient care. The first phase of this study focuses on evaluating the hospital’s implementation of initiatives to improve Child HCAHPS Survey measures for provider-family communication and responsiveness to the call button. The second phase of the study will evaluate how the use of new open-ended Narrative Items in development for the Child HCAHPS Survey influences the hospital’s quality improvement process and reporting.

Survey of Hospital Quality Leaders

The RAND CAHPS team led an effort to learn more about the ways in which hospitals use the CAHPS Hospital Survey (HCAHPS) and other information about patient experience of care. The RAND team surveyed hospital quality leaders with primary responsibility for patient experience to collect information about:

The role of HCAHPS in hospitals' efforts to improve patient experience.
The types of quality improvement activities hospitals implement to improve their HCAHPS scores.
Hospitals' perspectives on HCAHPS.
The types of information collected by hospitals beyond those required for value-based purchasing.

The findings from this national survey will describe how hospitals use HCAHPS data and provide insight into the perceptions held by hospital leadership about patient experience measures including HCAHPS, and activities engaged in to improve patient experience. This information will allow hospitals to learn from their peers with outstanding records of patient experience.

Case Studies on Improving Patient Experience with Hospital Care

Improving Hospital Inpatient Nursing Care (PDF, 604 KB). This case study by the research team at RAND describes a large acute care hospital's successful implementation of a six-step plan to improve the emotional support provided to inpatients by the registered nurses and the rest of the nursing staff. April 2010.

Improving Patient Experience in Other Settings

CAHPS In-Center Hemodialysis Quality Improvement Project. The CAHPS grantees and four ESRD Networks worked with a number of dialysis facilities to develop quality improvement initiatives based on CAHPS survey data.

Related Research

In addition to playing a role in many studies published in academic journals, members of the CAHPS team have contributed to the following research reports:

Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance. This AHRQ guide informs developers of feedback reports about evidence-based strategies to consider when developing or refining a feedback reporting system.

A Tale of Three Practices: How Medical Groups Are Improving the Patient Experience (PDF, 508 KB). This evidence brief by Shaller Consulting for the Robert Wood Johnson Foundation's Aligning Forces for Quality program discusses the benefits of measuring and reporting patient experience data for quality improvement in clinical practice. The focus of the evidence brief is on demonstrable changes that have been achieved through specific improvement interventions in three medical practices.

Improving Patient Experience in the Inpatient Setting: A Case Study of Three Hospitals (PDF, 561 KB). This case study by Shaller Consulting for the Robert Wood Johnson Foundation's Aligning Forces for Quality program discusses how three hospitals in different parts of the country achieved improvements in specific HCAHPS domains and shares five common themes in their approach to improving patient experience.

Patient-Centered Care: What Does It Take? In a paper commissioned by the Picker Institute and supported by The Commonwealth Fund, Dale Shaller (Yale Team) explored what is needed for widespread implementation of patient-centered care in inpatient and ambulatory care settings. The findings were based on interviews conducted with experts in designing or implementing strategies for achieving excellence in patient-centered care.

Review all citations for quality improvement in the CAHPS bibliography.

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