Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey.
OBJECTIVE
The US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients.


METHODS
Data were drawn from the Adelphi CKD Disease Specific Program (a retrospective, cross-sectional survey of nephrologists and patients). Selected United States-based nephrologists treating patients receiving hemodialysis completed patient record forms and provided information on their dialysis center. Patients (n=404) completed the CAHPS-ICH survey (comprising 58 questions) providing six scores for the assessment of patient experience of care. CAHPS-ICH item-scale convergence, discrimination, and reliability were evaluated for multi-item scales. Floor and ceiling effects were estimated for all six scores. Patient (demographics, dialysis history, vascular access method) and facility characteristics (size, ratio of patients-to-physicians, nurses, and technicians) associated with the CAHPS-ICH scores were also evaluated.


RESULTS
Item-scale correlations and internal consistency reliability estimates provided support for the nephrologists' communication (range, 0.16-0.71; α=0.81) and quality of care (range, 0.16-0.76; α=0.90) composites. However, the patient information composite had low internal consistency reliability (α=0.55). Provider-to-patient ratios (range, 2.37 for facilities with >36 patients per physician to 2.8 for those with <8 patients per physician) and time spent in the waiting room (3.44 for >15 minutes of waiting time to 3.75 for 5 to <10 minutes) were characteristics most consistently related to patients' perceptions of dialysis care.


CONCLUSIONS
CAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.
Adelphi Real World Ltd., Bollington, Cheshire, United Kingdom; robert.wood@adelphigroup.com.
Robert
R
Wood
Amgen, Inc., Thousand Oaks, California; and.
Carly J
CJ
Paoli
Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, California.
Ron D
RD
Hays
Adelphi Real World Ltd., Bollington, Cheshire, United Kingdom;
Gavin
G
Taylor-Stokes
Adelphi Real World Ltd., Bollington, Cheshire, United Kingdom;
James
J
Piercy
Amgen, Inc., Thousand Oaks, California; and.
Matthew
M
Gitlin
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards*; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011594:Psychometrics; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000592:standards*; D015203:Reproducibility of Results; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data
CAHPS-ICH; hemodialysis; patient experience of care; quality of care; reimbursement