Differences in the structure of CAHPS measures among the medicare fee-for-service, medicare managed care, and privately insured populations.
OBJECTIVE
To confirm in a new population, the Medicare fee-for-service population, the factor structure previously found in two Consumer Assessment of Health Plans Study (CAHPS) field-test surveys with Medicare HMO and adult privately insured populations.


METHODS
Primary data were collected in the fall of 1998. Survey responses from the Medicare Fee-for-Service CAHPS survey field test were compared to results from the Medicare HMO and adult privately insured field-test studies conducted in the fall of 1996.


METHODS
Respondents for the field-test survey were a random sample of Medicare beneficiaries in five states who had opted for the original Medicare plan (fee-for-service).


METHODS
Data were collected by a mailed survey with a telephone follow-up survey to those who did not return the mailed survey.


RESULTS
A confirmatory factor analysis in two different samples of Medicare fee-for-service beneficiaries provided basic support for a previously reported three-factor structure underlying the CAHPS reports and rating items: (1) quality of provider or staff communications; (2) timely access to quality health care; and (3) quality of plan administration. An exploratory factor analysis revealed a variant three-factor structure.


CONCLUSIONS
Because of differences in the factor structures among the different populations discussed, caution needs to be exercised in any composite development, based on factor analysis or any other basis, by which cross-population comparisons will be made. Comparisons should only be made on composites representing stable structure across all populations concerned.
Bender
R H
RH
Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
Garfinkel
S A
SA
D003258:Consumer Behavior / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D005163:Factor Analysis, Statistical; D018588:Fee-for-Service Plans / Q000592:standards*; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility; D006801:Humans; D007255:Information Services; D016345:Medicare Part B / Q000592:standards*; D010817:Physician-Patient Relations; D017149:Private Sector / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D014481:United States