Patterns of Unit and Item Nonresponse in the CAHPS<sup>®</sup> Hospital Survey

Elliott, Marc N.; Edwards, Carol A.; Angeles, January; Hambarsoomians, Katrin; Hays, Ron D.

doi:10.1111/j.1475-6773.2005.00476.x

Cited by 132 publications

(119 citation statements)

References 22 publications

Supporting

Mentioning

107

Contrasting

Unclassified

Order By: Relevance

“…The GP Patient Survey is a major national UK survey with a response rate (38%) that is comparable to similar surveys undertaken elsewhere in the world. 27 The lack of significant non-response bias in respect of some key measures in the survey has been reported previously. 28 This sample included a range of general practices in terms of demographic profile, geographic location, size, and GP Patient Survey scores.…”

Section: Strengths and Limitationsmentioning

confidence: 96%

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Asprey

Campbell²,

Newbould³

et al. 2013

Br J Gen Pract

View full text Add to dashboard Cite

BackgroundThe UK government has encouraged NHS services to obtain patient feedback to support the further development of patient-centred care. In 2009, the English GP Patient Survey included a sample of 5.5 million, but little is known about its potential utility in informing developments aimed at improving the quality of patients' experiences of primary care. AimTo investigate primary care providers' response to feedback on patient experience from a national survey. Design and settingQualitative interview study in 10 general practices from four primary care trusts in England. MethodSemi-structured interviews were conducted with GPs, practice nurses, and practice managers (n = 37). Transcripts were analysed thematically. ResultsAlthough some participants reported making changes to their practice in response to the survey data, many expressed doubts about the credibility of the results. Key issues included: concerns about practical aspects of the survey, such as the response rate and representativeness of the sample; the view that it gave insufficient detail to facilitate change and failed to address some salient issues; and unease about the influence of political influences underpinning its introduction and use. ConclusionAlthough, in general, primary care professionals have positive attitudes towards patient feedback, this study suggests a mismatch between the conventional demonstration of the objectivity of a questionnaire survey and the attitudes and experiences of those receiving the data. This is likely to prevent doctors from engaging constructively with the survey. These concerns may well militate against the potential of the survey to act as a simple means of capturing, and effectively using, feedback from patients. Keywordsprimary healthcare; qualitative research; reliability and validity; surveys.

show abstract

Section: Strengths and Limitationsmentioning

confidence: 96%

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Asprey

Campbell²,

Newbould³

et al. 2013

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…However, because we found no association between frequency of press conferences and any of our outcomes, this possibility is reduced. Because design-based weighting for characteristics not associated with parameters of interest can worsen the accuracy of estimates through variance inflation (Elliott et al 2005;Kish 1985), we elected to perform these regressions unweighted.…”

Section: Independent Variablesmentioning

confidence: 99%

When Does the Watchdog Bark? Conditions of Aggressive Questioning in Presidential News Conferences

2007

Self Cite

View full text Add to dashboard Cite

In theories of the journalism-state relationship, the watchdog model of journalism competes with other models emphasizing either subservient or oppositional relations. Since actual journalistic practice is circumstantially variable, this study isolates the social conditions associated with aggressive journalism. Data are drawn from presidential news conferences from 1953 to 2000, and the focus is on the aggressiveness of the questions asked therein. Through multivariate models, four sets of explanatory conditions are explored: (1) the administration life cycle, (2) presidential popularity, (3) the state of the economy, and (4) foreign affairs. Results show (1) no evidence of a firstterm honeymoon period, but significantly more aggressive questions during second terms, (2) the president's Gallup job approval rating is not a significant independent predictor of aggressiveness, (3) both the unemployment rate and the prime interest rate are positively associated with aggressiveness, and (4) questions about foreign affairs are significantly less aggressive than questions about domestic affairs, and this differential has been stable for at least a half-century. We conclude by discussing the theoretical implications of these findings, which show that journalists modulate their conduct in complex ways that do not readily map onto any single model.

show abstract

“…110 There has been extensive work on the reliability and validity of patient experience questionnaires. [111][112][113][114][115][116] However, although the face validity of communication items in questionnaires such as the GP Patient Survey has been well studied, evidence is sparser on whether or not the scores have construct validity, that is, whether or not behaviours that doctors may need to change are accurately represented by responses given in the questionnaires. For example, do patients reflect specifically on their experience of communication with the GP in their choice of response options or are they drawing on wider influences, which may be internal or external to the consultation?…”

Section: Introduction and Rationale For The Studymentioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Patterns of Unit and Item Nonresponse in the CAHPS^® Hospital Survey

Cited by 132 publications

References 22 publications

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

When Does the Watchdog Bark? Conditions of Aggressive Questioning in Presidential News Conferences

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Contact Info

Product

Resources

About

Patterns of Unit and Item Nonresponse in the CAHPS® Hospital Survey

Cited by 132 publications

References 22 publications

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study

When Does the Watchdog Bark? Conditions of Aggressive Questioning in Presidential News Conferences

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Contact Info

Product

Resources

About

Patterns of Unit and Item Nonresponse in the CAHPS^® Hospital Survey