Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences.
BACKGROUND
To complement a nursing home resident survey, the team developed a survey asking family members about their experiences with nursing homes. Although a family member does not receive care directly from a nursing home, their experiences at the nursing home and with staff can contribute to understanding nursing home quality.


OBJECTIVE
To describe how the nursing home family member instrument was developed, refined, tested, and finalized.


METHODS
The team developed a draft survey using information from a literature review, 12 focus groups with family members involved in choosing a nursing home for someone, review of nursing home surveys, and expert/stakeholder input. The survey went through 2 rounds of cognitive interviews (n=54) and revisions and was fielded in 15 nursing homes. Data from the pilot survey (n=885) were subjected to psychometric analyses to evaluate the measurement properties of items as well as the reliability and validity of the resulting composites. On the basis of these analyses and input from experts, the survey was finalized.


RESULTS
Focus groups and experts provided input into discerning important indicators of quality, although in some cases family members were not the best sources of information. Cognitive testing refined the survey and eliminated some of the proxy items. The field test analysis and input from experts eliminated 10 items. The final survey included 21 items organized into 4 composites.


CONCLUSIONS
This survey measures family members' experiences of nursing home care, and the results contribute to the understanding of quality of care in nursing homes.
American Institutes for Research, Chapel Hill, NC 27514, USA. efrentzel@air.org
Elizabeth M
EM
Frentzel
Judith A
JA
Sangl
Christian T
CT
Evensen
Carol
C
Cosenza
Julie A
JA
Brown
San
S
Keller
Steven A
SA
Garfinkel
D003258:Consumer Behavior / Q000706:statistics & numerical data; D005190:Family; D017144:Focus Groups; D019538:Health Care Surveys / Q000379:methods* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D011594:Psychometrics; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations