Clinician and Group CAHPS® Items Showing the Largest Differences for Highest and Lowest Rated Physicians: Exploratory Analysis

Importance of Clinician and Group CAHPS® Survey Results

This is the first of a series of blogs we will be producing over the coming months regarding our ongoing analysis of Clinician and Group (CG) CAHPS® data.  Given the likelihood that this survey will become the standard (like it or not) for measuring patient experience with physicians used by CMS on the Physician Compare website and, by default, by many others, it is important to understand the measures and their relative importance.

We are using a draft version of the Adult Primary care survey.  Surveys and other information about the program can be found at:

http://www.cahps.ahrq.gov/content/products/CG/PROD_CG_CG40Products.asp#V-S_Instrument .

This time, we are reporting on some exploratory analysis of the differences we found in CG CAHPS® results for physicians rated highest and lowest on the overall satisfaction question.  For this analysis, we looked at those physicians who scored in the top 20 per cent in comparison to those who scored in the bottom 20 per cent on the following question:

Using any number from 0 to 10, where zero is the worst doctor possible and 10 is the best doctor possible, what number would you use to rate your doctor?

The Data

For this analysis, we used CG CAHPS® patient survey results for approximately 300 physicians.  Data were collected by mail survey in the fall of 2010.  We looked at two kinds of items, those with response options categorical yes/no and those with response options never, almost never, sometimes, usually, almost always, and always.

Rating Differences

The top five items, 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):

Chart A


Complete text for the questions is as follows:

  • Q22 In the last 12 months, when this doctor ordered a blood test, x-ray or other test for you, how often did someone from this doctor’s office follow up to give you those results?
  • Q18 In the last 12 months, how often did this doctor seem to know the important information about your medical history?
  • Q12 In the last 12 months, when you phoned this doctor’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?
  • Q20 In the last 12 months, how often did this doctor spend enough time with you?
  • Q19 In the last 12 months, how often did this doctor show respect for what you had to say?

Categorical Questions

On the yes/no questions, looking at the percentage “yes” responses, the five items showing the greatest differences between top 20 percent and bottom 20 percent physicians are shown in Chart B:

Chart B


Complete text for the questions is as follows:

  • Q17f In the last 12 months, did you and this doctor talk about things in your life that worry you or cause you stress?
  • Q20f Choices for your treatment or health care can include choices about medicine, surgery, or other treatment.  In the last 12 months, did this doctor tell you there was more than one choice for your treatment or health care?
  • Q17e In the last 12 months, did you and this doctor talk about the exercise or physical activity you get?
  • Q14a In the last 12 months, were any of the explanations this doctor gave you hard to understand because of an accent or the way he or she spoke English?
  • Q17d In the last 12 months, did you and this doctor talk about a healthy diet and healthy eating habits?

Some Preliminary Conclusions

Based on this exploratory analysis of Clinician & Group CAHPS® measures, patients want physicians to:

  • Be familiar, or at least, appear to be familiar with their medical history.
  • Give them prompt feedback on medical test results.
  • Provide answers to their questions in a timely manner.
  • Spend “enough” time with them.  More on what this means in future analyses.
  • Show them respect.
  • Talk to them about issues that cause stress in their lives.
  • Give them options for treatment and engage them in the decision as to which option to pursue.
  • Provide advice regarding exercise, physical activity and healthy eating.
  • Be understandable.

We intend to explore these data further and to 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 (AHRQ).


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