Background The U.S. Centers for Medicare & Medicaid Services (CMS) assesses patient experiences of care as part of the End Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis survey (CAHPS® ICH survey). Study Design We conducted formative research to generate survey questions and conducted statistical analyses of survey responses to evaluate the survey’s measurement properties. Setting and Participants Formative research included 5 focus groups (2 with hemodialysis patients, 2 with caregivers, 1 with nephrologists) and 56 cognitive interviews with dialysis patients. We collected field test responses to the survey from 1454 dialysis patients receiving care at 32 facilities. Measurements & Outcomes We assessed the CAHPS ICH Survey. Results Response rate was 46%. Analyses support 3 multi-item scales: Nephrologists’ Communication and Caring (7 items, Cronbach’s alpha = 0.89); Quality of Dialysis Center Care and Operations (22 items, alpha = 0.93); and, Providing Information to Patients (11 items, alpha = 0.75). The communication scale was the most strongly correlated with the global rating of the ‘kidney doctor’ (r = 0.78). The Dialysis Center Care and Operations scale was most strongly correlated with the global ratings of staff (r = 0.75) and of the center (r = 0.69). Providing Information to Patients was most strongly correlated with the global rating of the staff (r=0.41). Limitations Males and younger patients were over-represented in the field test compared to the general U.S. population of dialysis patients. A relatively small number of patients completed the survey in Spanish. Conclusions This study provides support for the reliability and validity of the CAHPS ICH survey for assessing ESRD patient experiences of care at dialysis facilities. The survey can be used to compare care provided at different facilities.
Background There is a need for reliable and valid measures of cultural competence from the patient’s perspective. Objective This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) item set. Research Design Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using Cronbach alphas, and examined the validity of the measures using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis. Subjects A random stratified sample (based on race/ethnicity and language) of 991 enrollees, less than 65 years old, from two Medicaid managed care plans in California and New York. Measures CAHPS CC item set after excluding screener items and ratings. Results Confirmatory factor analysis (CFI= 0.98; TLI= 0.98; RMSEA= 0.06) provided support for a seven-factor structure: Doctor Communication-Positive Behaviors; Doctor Communication-Negative Behaviors; Doctor Communication-Health Promotion; Doctor Communication-Alternative Medicine; Shared Decision Making; Equitable Treatment; and Trust. Item--total correlations (corrected for item overlap) for the 7 scales exceeded 0.40. Exploratory factor analysis showed support for one additional factor: Access to Interpreter Services. Internal consistency reliability estimates ranged from 0.58 (Alternative Medicine) to 0.92 (Positive Behaviors), and was 0.70 or higher for four of the eight composites. All composites were positively and significantly associated with the overall doctor rating. Conclusions The CAHPS CC 26-item set demonstrates adequate measurement properties, and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient’s perspective.
Increased clinician awareness of the behaviors that patients believe are the drivers of a quality office visit can help clinicians improve patients' experience of care and experience-based measures of quality.
This paper aims to improve the applicability and relevance of contingency theory research in the field of Operations Management. Based on the results of previous studies, we have identified a systemsbased single definition of organisation types that could describe the fit between organisational environment and organisational structure. This definition of organisation type, which we call an 'organisational system', regards the organisation as an integrated whole instead of as a sum of its parts and can help to better classify organisations in order to identify fits between organisation types and emerging practices in Operations Management.
Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions. Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity. Principal Findings. Responses to both language versions exhibit similar patterns with respect to item-scale correlations, factor structure, content validity, and the association between each of the seven qualities of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish-language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions. The goal of this article is to compare the measurement properties of the Spanish and English versions of the H-CAHPS survey. We precede the psychometric analysis with a brief description of the procedures used for the survey translation and cultural adaptation, including a summary of the results of the cognitive interviews used to test the conceptual equivalence of the Spanish version of the H-CAHPS survey that preceded the field test. Unlike some other studies that examine the measurement properties of a translated survey instrument subsequent to and independently from the original version, in this article we simultaneously assess and compare the measurement properties of the source English version with the translated Spanish version. METHODS Development of the Spanish Version of the CAHPS Hospital Survey for the Pilot StudyThe Spanish translation and cultural adaptation of the original English-language H-CAHPS survey was conducted following an initial set of procedures established by the CAHPS cultural comparability team. First, a professional translator translated the questionnaire from English to Spanish. Second, another independent professional translator, blinded to the original source questionnaire, was provided with the Spanish translated version and asked to back-translate it into English. Third, a professional translation reviewer examined the products of the two translation...
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