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Your Voice Matters: Patient experience with primary care providers in Washington state

Washington Health Alliance plans to survey 140,000 patients!

Patients are the best source of information about their experience in their primary care provider’s office. While ensuring a positive patient experience is an important goal in itself, research has shown that patient experience is related to other aspects of health care quality as well as to the business vitality of a medical practice. Most importantly, a positive patient experience is linked to patients being more likely to follow their doctor’s advice and better patient outcomes. It has also been linked to financial performance, increased patient loyalty, improved employee satisfaction and a reduction in malpractice suits.

Beginning in early September 2015, the Washington Health Alliance will be undertaking a broad effort to measure and publicly report the experience patients have in their primary care doctor’s offices. This is the third time that the Alliance will undertake this survey. The results from the last survey can be found on the Alliance’s Community Checkup website. Over the years that the Alliance has been conducting this survey, we have learned that there is significant interest in patient experience results among providers and patients, as well as employers and health plans.

Patient experience will be measured using the Clinician-Group CAHPS (CG-CAHPS), a free, standardized survey available in the public domain through the CAHPS program, which is funded and administered by the U.S. Agency for Healthcare Research and Quality. CAHPS surveys are the most widely tested and used surveys for assessing patient experience of care in the U.S. and are endorsed by the National Quality Forum.

The use of patient surveys allows us to measure whether care is patient-centered, one of six essential aims for achieving high quality health care according to the Institute of Medicine.

This community-wide measurement and reporting effort will allow medical practices to compare their performance on patient experience to local market peers as well as to national benchmarks provided through the National CAHPS Benchmarking Database.

The Washington Health Alliance believes strongly in the maxim: “You cannot improve what you do not measure.” The CG-CAHPS survey was explicitly developed to provide actionable information for improvement. Evidence has shown that patient experience can be improved through concerted and systematic efforts. Resources exist to help medical practices make systematic changes to improve care, such as the CAHPS Improvement Guide.

Implementation strategy

The Washington Health Alliance is implementing the community-wide measurement of patient experience using a well-respected vendor, The Center for the Study of Services (CSS), which will administer the mail-based survey community-wide. CSS has been conducting health care survey research for more than 30 years and, in particular, has extensive experience working with CAHPS surveys. Use of a single, centralized vendor like CSS guarantees patient privacy as well as standardization of sampling and data collection protocol which ensure comparability of results among all practices being measured.

The first wave of the survey will be mailed in early September to approximately 140,000 individuals who are randomly selected from a patient sample provided by seven commercial and Medicaid insurance plans. The sample will query patients who utilize primary care providers at hundreds of primary care clinics across a 14-county area (Benton, Chelan, Douglas, Franklin, King, Kitsap, Kittitas, Pierce, Skagit, Snohomish, Spokane, Thurston, Whatcom and Yakima counties). A second wave of mailings will go out in late September to boost responses.

Why this survey is unique

Some medical groups are already measuring patient experience relying upon their own survey activities. However, these medical groups are using a number of different survey tools and techniques, making it very difficult to compare results across medical groups in a meaningful way. In addition, few, if any, of these medical groups currently share their results with the public. Moreover, many practices are not currently measuring patient experience for any number of reasons, including not having the resources to conduct survey activities on their own. These practices now have the opportunity to receive information about their performance for this important quality indicator.

Many physicians are unaware of the amount of ratings that already exist on the Internet. Unfortunately, many of these “ratings” are based solely on patient comments that are gathered and widely shared, often with minimal filtering. The Washington Health Alliance believes that patient experience is an important and serious indicator of quality and, as such, should be measured in a statistically reliable manner that produces valid, comparable results.

Public reporting of results

During first quarter 2016, the Washington Health Alliance will publicly report patient experience scores based on patient survey results at the clinic level for all primary care clinics with four or more providers for whom they have statistically reliable results. Measures to be reported include four composite measures (indicated with a *) and a fifth measure that reflects responses to a single question. Composite measures are used to summarize responses to multiple questions that are addressing a similar topic.

  1. How Well Providers Communicate with Patients*
  2. Access to Timely Appointments, Care and Information*
  3. Care Coordination*
  4. Helpful, Courteous and Respectful Office Staff*
  5. Overall Rating of the Provider

Results will be published via written report and on the Community Checkup website.

Results will be reported as top-box scores, which is the percentage of responses in the most positive response category. For example, the proportion of respondents who replied “always” to the survey item that asks how often the doctor listened carefully to what they had to say (with “always” representing the most positive answer possible) is the top-box score for that survey item.

Communicating about the survey

Primary care medical groups and clinics are encouraged to communicate with their patients that they may receive this survey (remember, patients are randomly selected). It is important in communications (public or one-on-one with patients) to be positive and to guard against defensive or dismissive comments about the patient experience survey. The results from national focus groups tell us that a negative attitude from physicians/medical groups can inadvertently signal indifference to patient-centered care and a lack of respect for patient opinion.

Here are a few of suggestions about how to convey a positive message about the survey:

  • The providers in our medical group/clinic support greater transparency in health care through measurement activities such as the patient experience survey. The patient experience survey results will provide an important source of information for our practice about our performance in delivering patient-centered care and can be used to identify specific areas for improvement.
  • Acknowledge the importance of giving patients the chance to voice their experience and the practice’s commitment to listening to its patients in order to improve.
  • We think it’s important for patients to have information that allows them to see how well medical groups deliver high quality care and we understand that the patient’s experience is an important part of quality.

For more information about the patient experience survey, please contact Susie Dade at the Washington Health Alliance: sdade@wahealthalliance.org.

Published: August 4, 2015

About Washington Health Alliance

The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 185 member organizations. A cornerstone of the Alliance's work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).

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