Differential use of the CAHPS® 0–10 global rating scale by medicaid and commercial populations

Abstract

The primary objective of this study was to investigate whether Medicaid managed care enrollees and commercially insured health plan participants respond differently to the CAHPS R 2.0 health plan survey global ratings of health care, personal doctor or nurse, and health plan. A secondary objective was to examine whether and how these differences may vary by alternative approaches to collapsing the 0-10 response scale. This study is a secondary analysis of CAHPS 2.0 health plan survey data collected in 1999 and 2000. Data on 2,142 Iowa Medicaid managed care enrollees and 1,051 commercially insured State of Iowa employees were analyzed. Differences in responses between the Medicaid-enrolled and commercially insured respondents were modeled using multinomial logistic regression, adjusting for demographics, health status and CAHPS composite measures. Results of these analyses indicated that Medicaid enrollees were significantly more likely than State of Iowa employees to use the extreme ends of the CAHPS global rating scales, particularly in the approaches when the category representing the highest end of the scale was defined as a score of 10 for the analysis. Thus, the choice of cut points for collapsing the 0-10 scales influenced statistical differences on CAHPS global ratings of care, doctor and health plan between Medicaid and privately insured populations. In conclusion, a populations use of the * This paper does not necessarily represent the views of the 194 Health Serv Outcomes Res Method (2004) 5: 193-205 extremes of the global rating scales should be considered when comparing or combining CAHPS data for different populations. If response contraction bias is present, a format such as the alternative approach presented here (using categories 0-4, 5-8, 9, 10) that captures that bias may be preferable to the CAHPS format, which has been shown to maximize plan differentiation. Springer

The Relationship Between Multimorbidity and Patients’ Ratings of Communication

“…However, our data are typical of patient experience and satisfaction data, which tend to be skewed toward more favorable assessments of providers. 41,42 Because it is unlikely that publicly reported performance data or data used for pay-for-performance programs would have normally distributed patient experience ratings data, the relationship between multimorbidity and patient experience ratings that we observed in our analysis would likely be observed in any quality improvement program that relies on patient experience ratings.…”

Perceived quality of communication amongst outpatients in western and traditional Chinese medicine clinics in a Chinese population

“…Multinominal logistic regression analyses were conducted to evaluate differences in assessment rating between various independent and case-mix variables. Reference groups for the four communication items were the "agree" categories, while for the global rating question the "5-8 points" group was chosen [10,11]. All statistical analyses were carried out using SPSS 14.0.…”

“…According to the CAHPS 2.0 reporting guideline [10], the four point Likert scale responses on the 4 communication questions were transformed into three categories (strongly disagree and disagree/agree/strongly agree). For the 0-10 responses of the global rating question, data were transformed into four categories (0-4/5-8/9/10), according to Damiano et al's recommendation [11].…”

Racial/Ethnic Differences in Patients’ Perceptions of Inpatient Care Using the HCAHPS Survey

“…Differences in global ratings have been attributed in part to cultural differences in the use of 0 to 10 ratings scales (Damiano, Elliott, Tyler, & Hays, 2004;Elliott, Haviland et al, 2009;Weech-Maldonado et al, 2008). Another study of commercial and Medicaid-managed care plans found that members of racial and ethnic minority groups, with the exception of Asians/Pacific Islanders, report similar experiences of care compared with non-Hispanic Whites .…”