Providing Consumers with Information About the Quality of Health Plans: The Consumer Assessment of Health Plans Demonstration in Washington State

Guadagnoli, Edward; Epstein, Arnold M.; Zaslavsky, Alan M.; Shaul, James A.; Veroff, David R.; Fowler, Floyd J.; Cleary, Paul D.

doi:10.1016/s1070-3241(00)26034-3

Cited by 21 publications

(11 citation statements)

References 20 publications

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“…[4,5] Insurers, particularly managed care companies, are routinely compared on how well they insure that preventive health services are delivered to their subscribers. [6] Surgeons' mortality rates are publicly reported in several US states while ambulatory practices' performance in holding down waiting times and measuring blood glucose levels is compared and providers are rewarded accordingly. [7,8] Finally, since late 2002 all nursing homes in the US are compared on numerous quality indicators developed over the past decade, and the results regularly advertised in local newspapers and posted permanently on a web site.…”

Section: Introductionmentioning

confidence: 99%

Inter-rater reliability of nursing home quality indicators in the U.S

Mor

Angelelli

Jones

et al. 2003

BMC Health Serv Res

173

161

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BackgroundIn the US, Quality Indicators (QI's) profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators.MethodsWe sampled nursing homes in 6 states, selecting up to 30 residents per facility who were observed and assessed by research nurses on 100 clinical assessment elements contained in the Minimum Data Set (MDS) and compared these with the most recent assessment in the record done by facility nurses. Kappa statistics were generated for all data items and derived for 22 QI's over the entire sample and for each facility. Finally, facilities with many QI's with poor Kappa levels were compared to those with many QI's with excellent Kappa levels on selected characteristics.ResultsA total of 462 facilities in 6 states were approached and 219 agreed to participate, yielding a response rate of 47.4%. A total of 5758 residents were included in the inter-rater reliability analyses, around 27.5 per facility. Patients resembled the traditional nursing home resident, only 43.9% were continent of urine and only 25.2% were rated as likely to be discharged within the next 30 days.Results of resident level comparative analyses reveal high inter-rater reliability levels (most items >.75). Using the research nurses as the "gold standard", we compared composite quality indicators based on their ratings with those based on facility nurses. All but two QI's have adequate Kappa levels and 4 QI's have average Kappa values in excess of .80. We found that 16% of participating facilities performed poorly (Kappa <.4) on more than 6 of the 22 QI's while 18% of facilities performed well (Kappa >.75) on 12 or more QI's. No facility characteristics were related to reliability of the data on which Qis are based.ConclusionWhile a few QI's being used for public reporting have limited reliability as measured in US nursing homes today, the vast majority of QI's are measured reliably across the majority of nursing facilities. Although information about the average facility is reliable, how the public can identify those facilities whose data can be trusted and whose cannot remains a challenge.

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Section: Introductionmentioning

confidence: 99%

Inter-rater reliability of nursing home quality indicators in the U.S

Mor

Angelelli

Jones

et al. 2003

BMC Health Serv Res

173

161

View full text Add to dashboard Cite

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“…Does providing summaries of the continuity of care that practices (or plans) achieve affect patient selection of insurers or clinicians, as Consumer Assessment of Health Plan data currently does? [21][22][23] I look forward to the answers to these and other related questions, perhaps in the pages of a subsequent issue of Annals of Family Medicine.…”

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confidence: 99%

Continuity of Care: Process or Outcome?

Christakis¹

2003

The Annals of Family Medicine

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“…When disseminated to patients, CAHPS data have been shown to be important to patients' selection of providers and plans. 6,7 In an increasingly competitive medical market place, consumer selection can therefore be used to drive quality improvement. 8,9 Given health plans' apparent interest in identifying modifiable attributes of care that might improve patient satisfaction and therefore their CAHPS scores, there is a need to identify features of care delivery that are associated with high CAHPS ratings.…”

mentioning

confidence: 99%

“…10 Some studies have compared plans and features of plans with respect to their assessments in CAHPS surveys. 7 Other studies have examined the association of demographic variables and CAHPS responses. 11 Few studies have focused on attributes of care delivery that may be associated with higher CAHPS assessments.…”

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confidence: 99%

Continuity of Care Is Associated With High-Quality Careby Parental Report

et al. 2002

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ABSTRACT. Context. The benefits of continuity of pediatric care remain controversial.Objective. To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and improved quality of care by parental report.Design. Cross-sectional study. Setting and Population. Seven hundred fifty-nine patients presenting to a primary care clinic completed surveys, which included validated measures of provider and clinic quality of care from the Consumer Assessment of Health Plan Survey.Main Exposure Variable. A continuity of care index that quantifies the degree to which a patient has experienced continuous care with a provider.Main Outcome Measures. The likelihood of parents reporting quality of care as high in several providerspecific items including reporting that providers respected what they had to say, treated them with courtesy and respect, listened to them carefully, explained things in a way they could understand, and spent enough time with their children. In addition, participants were asked to rate the overall quality of the clinic and their child's provider on a 10-point scale.Results. In ordered logistic regression models, continuity of care was associated with statistically significantly higher Consumer Assessment of Health Plan Survey scores for 5 of the 6 items, including feeling that providers respected what parents had to say; listened carefully to them; explained things in a way that they could understand; asked about how their child was feeling, growing, and behaving; and spent enough time with their child. In addition, greater continuity of care was associated with a higher clinic rating, as well as a higher provider rating.Conclusions. Greater continuity of primary care is associated with higher quality of care as reported by parents. Efforts to improve and maintain continuity may be warranted. Pediatrics 2002;109(4). URL: http://www. pediatrics.org/cgi/content/full/109/4/e54; continuity of patient care, pediatrics, ambulatory care, CAHPS, quality of care, patient satisfaction.

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Providing Consumers with Information About the Quality of Health Plans: The Consumer Assessment of Health Plans Demonstration in Washington State

Cited by 21 publications

References 20 publications

Inter-rater reliability of nursing home quality indicators in the U.S

Inter-rater reliability of nursing home quality indicators in the U.S

Continuity of Care: Process or Outcome?

Continuity of Care Is Associated With High-Quality Careby Parental Report

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