Home Health CAHPS® Items Showing the Largest Differences for Highest and Lowest Rated Home Health Agencies (HHA): Exploratory Analysis

Importance of HH CAHPS® Survey Results

This is the first of several blogs we will be producing regarding our ongoing analysis of HH-CAHPS® data.  The CMS Home Health Compare website is up today and HH-CAHPS® results will be available starting in first quarter 2012.  Agencies that do not participate are subject to a 2% reduction in their Medicare reimbursement.  So, there are good reasons to understand the measures and their relative importance.

We are using the HH-CAHPS® survey, developed by AHRQ in conjunction with CMS.  Information about the survey and program can be found at www.homehealthcahps.org.

There are 34 questions on the standard survey with the opportunity to add 10 questions.

In this blog, we are reporting on some exploratory analysis of the differences we found in HH- CAHPS® results for HHAs rated highest and lowest on the overall satisfaction question.  Further, for this analysis, we looked at those HHAs that scored in the top 10 percent in comparison to those who scored in the bottom 10 percent on the following question:

  • Q20. We want to know your rating of your care from this agency’s home health providers.  Using any number from 0 to 10, where 0 is the worst home health care possible and 10 is the best home health care possible, what number would you use to rate your care from this agency’s home health providers?

The Data

For this analysis, we used HH-CAHPS® patient survey results for more than 350 HHAs.  Data were collected by primarily by mail and, to lesser extent, telephone survey from January 2010 to July 2011.  We looked at two kinds of items, those with categorical response options of yes/no and those with rating response options never, almost never, sometimes, usually, almost always, and always.

Rating Differences

The top six items (there are only six yes/no items – see following), the ones with the largest differences, on the never to always scale, comparing the differences between the combined always + almost always results are shown in Chart A (in order from largest difference):

Complete text for the questions is as follows:

  • Q15. In the last 2 months of care, how often did home health providers from this agency keep you informed about when they would arrive at your home?
  • Q9. In the last 2 months of care, how often did home health providers from this agency seem informed and up-to-date about all the care or treatment you got at home?
  • Q17. In the last 2 months of care, how often did home health providers from this agency explain things in a way that was easy to understand?
  • Q18. In the last 2 months of care, how often did home health providers from this agency listen carefully to you?
  • Q19. In the last 2 months of care, how often did home health providers from this agency treat you with courtesy and respect?
  • Q16. In the last 2 months of care, how often did home health providers from this agency treat you as gently as possible?

Categorical Questions

Looking at the percentage “yes” responses the six yes/no questions. Differences between top 10 percent and bottom 10 percent HHAs are shown in Chart B:

Complete text for the questions is as follows:

  • Q14. In the last 2 months of care, did home health providers from this agency talk with you about the side effects of these medicines?
  • Q13. In the last 2 months of care, did home health providers from this agency talk with you about when to take these medicines?
  • Q3. When you first started getting home health care from this agency, did someone from the agency talk with you about how to set up your home so you can move around safely?
  • Q12. In the last 2 months of care, did home health providers from this agency talk with you about the purpose for taking your new or changed prescription medicines?
  • Q5. When you started getting home health care from this agency, did someone from the agency ask to see all the prescription and over-the-counter medicines you were taking?
  • Q4. When you started getting home health care from this agency, did someone from the agency talk with you about all the prescription and over-the-counter medicines you were taking?

Some Preliminary Conclusions

Charts A and B show the items with the largest differences for the top 10% and bottom 10% of HHAs.  Getting higher ratings on these particular items will, in turn, produce higher overall ratings for an HHA.  Of the items on these charts, five stand out as very high impact items.  Some of these should be relatively simple to address while others may require more careful thinking and planning.  To have the highest impact on your overall ratings:

  • Inform patients in the most timely and accurate way possible about when you will arrive at their home.  It may be possible, for example, to use text messaging to inform patients about delays.
  • Be informed and up-to-date about the care that patients have previously received at home.  This is critical; it takes a bit of time to review information on past treatment, but showing that you know what has been done pays big dividends with patients.  It should be noted that this finding is consistent with what we find in other patient/provider studies.
  • Make sure that you talk about the side effects of medications that patients are taking.
  • Make sure that you talk about and are clear about when to take medications.
  • Make it a point to talk to patients about how to set up things in their home so they can move around safely.

We will explore these survey data further and report on other findings in future blogs.  As noted at the beginning, we view these results as exploratory in nature and plan to expand our analyses to larger numbers of physicians.

® CAHPS is a registered trademark of the Agency for Healthcare Research and Quality, a U.S. Government Agency.

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