Case-mix Adjustment of the CAHPS Hospital Survey

Overview

Journal Health Serv Res

Specialty Health Services

Date 2005 Dec 1

PMID 16316443

Citations 97

Authors

A James OMalley

Alan M Zaslavsky

Marc N Elliott

Lawrence Zaborski

Paul D Cleary

Affiliations

Soon will be listed here.

Abstract

Objectives: To develop a model for case-mix adjustment of Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital survey responses, and to assess the impact of adjustment on comparisons of hospital quality.

Data Sources: Survey of 19,720 patients discharged from 132 hospitals.

Methods: We analyzed CAHPS Hospital survey data to assess the extent to which patient characteristics predict patient ratings ("predictive power") and the heterogeneity of the characteristics across hospitals. We combined the measures to estimate the impact of each predictor ("impact factor") and selected high impact variables for adjusting ratings from the CAHPS Hospital survey.

Principle Findings: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service. Adjustment for GHS and education affected scores in each of the three services, while age and being non-Hispanic black had important impacts for those receiving surgery or medical services. Circulatory disorder, Spanish language, and Hispanic affected scores for those treated on surgery, obstetrics, and medical services, respectively. Of the 20 medical conditions we tested, only circulatory problems had an important impact within any of the services. Results were consistent for the overall ratings of nurse, doctor, and hospital. Although the overall impact of case-mix adjustment is modest, the rankings of some hospitals may be substantially affected.

Conclusions: Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals.

Citing Articles

Case-mix adjustments for patient reported experience and outcome measures in primary care: an empirical approach to identify patient characteristics as case-mix adjusters based on a secondary analysis of an international survey among patients and....

Groenewegen P, Spreeuwenberg P, Leyland A, de Boer D, Boerma W J Patient Rep Outcomes. 2023; 7(1):127.

PMID: 38048040 PMC: 10695892. DOI: 10.1186/s41687-023-00667-8.

More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients.

Yu C, Xian Y, Jing T, Bai M, Li X, Li J Front Public Health. 2023; 11:1148277.

PMID: 37927879 PMC: 10620693. DOI: 10.3389/fpubh.2023.1148277.

Effect of patient-related factors on hospitalization service satisfaction and recommendation intention of medical institutions in Korea.

Shin J, Choi B BMC Health Serv Res. 2023; 23(1):716.

PMID: 37391768 PMC: 10311881. DOI: 10.1186/s12913-023-09754-4.

Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey.

Liu M, Hu L, Xu Y, Wang Y, Liu Y Front Public Health. 2023; 11:1059878.

PMID: 36908411 PMC: 9992183. DOI: 10.3389/fpubh.2023.1059878.

Patient satisfaction among persons living with HIV/AIDS and receiving antiretroviral therapy in urban Uganda: A factor analysis.

Sekandi J, Castellanos M, Woldu H, Kakaire R, Mutembo S, Mutanga J PLoS One. 2023; 18(2):e0280732.

PMID: 36730252 PMC: 9894454. DOI: 10.1371/journal.pone.0280732.

References

Elliott M, SWARTZ R, Adams J, Spritzer K, Hays R . Case-mix adjustment of the National CAHPS benchmarking data 1.0: a violation of model assumptions?. Health Serv Res. 2001; 36(3):555-73. PMC: 1089242. View

Hargraves J, Wilson I, Zaslavsky A, James C, Walker J, Rogers G . Adjusting for patient characteristics when analyzing reports from patients about hospital care. Med Care. 2001; 39(6):635-41. DOI: 10.1097/00005650-200106000-00011. View

Zaslavsky A, Zaborski L, Ding L, Shaul J, Cioffi M, Cleary P . Adjusting Performance Measures to Ensure Equitable Plan Comparisons. Health Care Financ Rev. 2014; 22(3):109-126. PMC: 4194711. View

McNEILL J, Sherwood G, Starck P, Nieto B . Pain management outcomes for hospitalized Hispanic patients. Pain Manag Nurs. 2001; 2(1):25-36. DOI: 10.1053/jpmn.2001.22039. View

Ehnfors M, SMEDBY B . Patient satisfaction surveys subsequent to hospital care: problems of sampling, non-response and other losses. Qual Assur Health Care. 1993; 5(1):19-32. DOI: 10.1093/intqhc/5.1.19. View

Cleary P, McNeil B . Patient satisfaction as an indicator of quality care. Inquiry. 1988; 25(1):25-36. View

Goldstein E, Farquhar M, Crofton C, Darby C, Garfinkel S . Measuring hospital care from the patients' perspective: an overview of the CAHPS Hospital Survey development process. Health Serv Res. 2005; 40(6 Pt 2):1977-95. PMC: 1361247. DOI: 10.1111/j.1475-6773.2005.00477.x. View

Wilson I, Ding L, Hays R, Shapiro M, Bozzette S, Cleary P . HIV patients' experiences with inpatient and outpatient care: results of a national survey. Med Care. 2002; 40(12):1149-60. DOI: 10.1097/00005650-200212000-00003. View

Kim M, Zaslavsky A, Cleary P . Adjusting Pediatric Consumer Assessment of Health Plans Study (CAHPS) Scores to Ensure Fair Comparison of Health Plan Performances. Med Care. 2005; 43(1):44-52. View

10.

Cleary P, Keroy L, Karapanos G, McMullen W . Patient assessments of hospital care. QRB Qual Rev Bull. 1989; 15(6):172-9. DOI: 10.1016/s0097-5990(16)30288-3. View

11.

Landon B, Zaslavsky A, Bernard S, Cioffi M, Cleary P . Comparison of performance of traditional Medicare vs Medicare managed care. JAMA. 2004; 291(14):1744-52. DOI: 10.1001/jama.291.14.1744. View

12.

Elliott M, Edwards C, Angeles J, Hambarsoomians K, Hays R . Patterns of unit and item nonresponse in the CAHPS Hospital Survey. Health Serv Res. 2005; 40(6 Pt 2):2096-119. PMC: 1361246. DOI: 10.1111/j.1475-6773.2005.00476.x. View

13.

Rosenheck R, Wilson N, Meterko M . Influence of patient and hospital factors on consumer satisfaction with inpatient mental health treatment. Psychiatr Serv. 1997; 48(12):1553-61. DOI: 10.1176/ps.48.12.1553. View

14.

Zaslavsky A, Zaborski L, Cleary P . Does the effect of respondent characteristics on consumer assessments vary across health plans?. Med Care Res Rev. 2000; 57(3):379-94. DOI: 10.1177/107755870005700307. View

15.

Arnetz J, Arnetz B . The development and application of a patient satisfaction measurement system for hospital-wide quality improvement. Int J Qual Health Care. 1996; 8(6):555-66. DOI: 10.1093/intqhc/8.6.555. View

16.

Hargraves J, Hays R, Cleary P . Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. Health Serv Res. 2004; 38(6 Pt 1):1509-27. PMC: 1360961. DOI: 10.1111/j.1475-6773.2003.00190.x. View

17.

Woodbury D, Tracy D, McKnight E . Does considering severity of illness improve interpretation of patient satisfaction data?. J Healthc Qual. 1998; 20(4):33-40. DOI: 10.1111/j.1945-1474.1998.tb00270.x. View

18.

Jenkinson C, Coulter A, Bruster S . The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care. 2002; 14(5):353-8. DOI: 10.1093/intqhc/14.5.353. View

19.

Hoff R, Rosenheck R, Meterko M, Wilson N . Mental illness as a predictor of satisfaction with inpatient care at Veterans Affairs hospitals. Psychiatr Serv. 1999; 50(5):680-5. DOI: 10.1176/ps.50.5.680. View

20.

Nguyen Thi P, Briancon S, Empereur F, Guillemin F . Factors determining inpatient satisfaction with care. Soc Sci Med. 2002; 54(4):493-504. DOI: 10.1016/s0277-9536(01)00045-4. View