Consumer assessments of care for children and adults in health plans: how do they compare?
OBJECTIVE
The Consumer Assessment of Health Plans Survey (CAHPS) includes an adult version and also a child version for parents or caretakers to rate children's care in health plans. This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys.


METHODS
Data were from 136 commercial health plans participating in the National CAHPS Benchmarking Database, with 80,539 adults and 40,003 children. We compared mean assessments for adults and children on four global ratings and five composites, and determined respondent characteristics predictive of these assessments using regression analysis. We calculated correlations of plan mean scores for adults and children and kappa statistics for agreement when health plans are ranked as above average, average, or below average performers based on adult and child scores.


RESULTS
CAHPS scores for children were significantly (P <0.001) higher than those for adults, except for customer service (lower for children) and specialist ratings. Similar respondent characteristics predicted adult and child scores. Plan-level correlations between corresponding adult and child mean scores were moderate to high (r = 0.60-0.85), which translate into fair to moderate agreement (kappa = 0.27-0.61) in ranking health plans.


CONCLUSIONS
Adult and child CAHPS provide similar scores and plan rankings on many aspects of care. Child reports include information that may be useful for consumer choice and to health plans for targeting quality improvement. Methods should be developed for assessing health care for children that minimize cost and respondent burden.
Zhan
Chunliu
C
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA.
Sangl
Judith
J
Meyer
Gregg S
GS
Zaslavsky
Alan M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D016536:Competitive Medical Plans / Q000706:statistics & numerical data*; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D014481:United States