[Federal Register Volume 69, Number 159 (Wednesday, August 18, 2004)]
[Notices]
[Pages 51312-51314]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-18851]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Ambulatory Care CAHPS[reg] (ACAHPS) Test
Sites
AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS.
ACTION: Notice of request.
-----------------------------------------------------------------------
SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is
soliciting volunteer sites for the testing of a draft Ambulatory
CAHPS[reg] (ACAHPS) instrument. This instrument will be part
of a suite of standardized patient surveys that are reliable, valid,
and provide a flexible, modular approach to measurement. This goal is
in direct response to requests from stakeholders to revise the
CAHPS[reg] tool in order to measure different levels of
ambulatory health care to provide practical information for quality
improvement for multiple and more varied audiences. The result will be
data derived from patients' perspectives that are more actionable for
quality improvement than the current CAHPS[reg] instrument.
AHRQ has initiated the redesign of the CAHPS instrument to include
different levels of ambulatory health care delivery, i.e., services
provided by individual primary care clinicians (such as physicians,
physician assistants, or nurse practitioners), sites of care (that is a
particular geographic location or facility from which care is
delivered) or group practices (where two or more practitioners legally
organize as a medical group to deliver care under certain conditions),
and health plans (the payor of health care services in either fee-for-
service or managed care arrangements). These levels are not necessarily
relevant to all survey users. The modular approach to the ACAHPS
instrument allows users to assess the quality of ambulatory care in
their particular market while maintaining comparability to the CAHPS
survey users in other markets.
AHRQ will respond to stakeholder input to provide users with a
flexible and modular approach to assess the quality of ambulatory care
for all of the functions at each of the delivery levels listed above,
using instruments specific to plans, groups or sites, or physicians.
Presently, we are interested in soliciting volunteers to be test sites
for the ACAHPS instrument. The instrument will be tested beginning in
2004 and continuing into 2005.
Testing the ACAHPS Instrument
Survey Method Issues
The following are some examples to methodological studies that AHRQ
plans to address during the pilot test of the ACAHPS instrument, and
which you may be willing to participate in:
1. Testing of mode effects (mail versus telephone) within levels of
ambulatory care. Because ACAHPS will be fielded by both mail and
telephone it is a primary concern to test and revise the instrument in
these two modes in order to ensure comparability across these modes.
2. Testing in other modes. We are also interested in testing ACAHPS
administration in other modes to assess mode effect and response rates.
3. Testing the use of screener items versus non- screener items.
CAHPS[reg] surveys traditionally use some screener items to
establish whether the respondent falls within a particular category to
determine whether a question is appropriate or whether the response in
meaningful. Through additional testing of the draft instrument, it can
be determined whether screeners are necessary and appropriate.
4. Assessing the impact on measurement of similar concepts when
using a reference period of care versus visit-specific care. Some
surveys at the physician level and group level use a visit-specific
reference for survey items. Others use a reference period (e.g., the
last six months).
5. Testing the adequacy of different response scales. We wish to
test the benefits of scales of differing lengths (e.g., four vs. six
points).
6. Assessing supplemental item placement. We wish to test the
effects of embedding additional questions within the ACAHPS instrument.
7. Testing the equivalence of the English and Spanish versions of
the draft instrument.
8. Assessing the correlation of survey measures with clinical
measures of quality.
9. Testing the effect on response rate of different survey
materials, taking into account incremental changes in cost. There is
some evidence in the survey research literature that response rate can
[[Page 51313]]
be influenced by the type of survey materials used. As a general rule,
impersonal materials from a source of lower status will result in lower
response rates than personalized materials from a source of higher
status. Cost could be an issue, as personalized materials may cost more
than impersonal materials.
10. Psychometric analyses to evaluate the instrument. Examples of
characteristics to be evaluated are:
Quality of item responses (missing item rates, skip
pattern errors);
Factors associated with item response rates;
Factors associated with survey response rates;
Construct validity of composites and ratings;
Internal consistency;
Language equivalence;
Components of variance; and
Case mix adjustment.
11. Assessing sampling and survey operations procedures.
Criteria for Additional Test Site Selection
While AHRQ would ideally like to provide wide access to the survey
for testing, resource limitations require the establishment of some
selection criteria. Test sites must be able to provide the resources
for data collection using the ACAHPS survey and agree to submit the
data to a central repository for analysis. Ambulatory care plans,
groups, and physicians may volunteer to participate in the testing
program individually, or in a group, in cooperation with an association
or other coalition. Potential testing sites will be chosen based on
their ability to meet the analytic needs of the ACAHPS development
effort. Thus, selection from among potential candidate sites will be
made using the practical criteria enumerated below. Criteria for
selection of the voluntary test sites are designed to achieve diversity
in the characteristics of the sites, obtain the most reliable and valid
data possible, and to maximize the use of limited resources allotted
for this work.
For selection, a test site must:
1. Be able to pay the full cost of data collection and database
creation using specifications provided by AHRQ;
2. Be able to field the survey within the timeframe specified by
AHRQ to be determined at the time of selection (Most of the testing
will be done in 2004 and 2005. Applicants should indicate their ability
to carry out the work during those periods.);
3. Employ a survey vendor with an established record of patient
survey experience;
4. Be able to provide an adequate sample size to meet the needs of
analyses;
5. Be able to adapt survey implementation as requested by AHRQ to
meet the needs of the experimental design; and
6. Be able to provide a person to coordinate the test site work
with AHRQ.
Selection of test sites will be determined at the sole discretion
of AHRQ.
Information Requirements: To volunteer to participate as a
voluntary test site, please provide the following information:
1. Volunteer site(s) name(s) and location(s).
2. Contact person information including name and title, address,
telephone number, fax number and e-mail address.
3. Coordinator for site data collection information (if different
from contact person) including name and title, address, telephone
number, fax number and e-mail address.
4. Indication of which studies you will or will not be willing to
participate in (See list of possible studies in Survey Method Issues
under Testing the ACHPS Instrument.).
5. Number of plans/groups/sites/physicians proposed for inclusion
in the testing.
6. Evidence that plan/group/site/physician is willing to
participate (i.e., acknowledgement or confirmation from senior
administrator).
7. Average number of patient visits per month.
8. Number of patients.
9. Name of current surveys being used by the site and modes of
administration of each survey used.
10. Name of current survey vendors working with site(s).
11. Statement or affidavit indicating authorization to commit the
organization(s) to pay the specific estimated cost of sample selection,
data collection, database preparation and coordination with AHRQ.
12. Current schedule for data collection of patient survey data, if
you have one.
13. Process and schedule for selecting a vendor for the proposed
testing or name of vendor already selected.
DATES: Please submit requested information on or before October 18,
2004.
ADDRESSES: Submissions should include a brief cover letter and the
requested information about the potential site(s). They may be in the
form of an e-mail with attachments, or a letter, preferably with an
electronic file in a standard word processing format, (e.g., Microsoft
Word or Word Perfect) on a 3\1/2\ inch diskette. E-mail submissions are
preferred and will be acknowledged upon receipt.
FOR FURTHER INFORMATION CONTACT: E-mail responses to this request
should be submitted to, or for further information contact: Charles
Darby, Agency for Healthcare Research and Quality, 540 Gaither Road,
Rockville, MD 20904, Phone: (301) 427-1324, Fax: (301) 427-1341, E-
mail: [email protected].
In order to facilitate handling of submissions, please include all
requested information about the candidate facilities. Please do not use
acronyms. Electronic submissions are strongly encouraged.
SUPPLEMENTARY INFORMATION: There are several functional areas of
ambulatory care that existing instruments (or items) speak to at
specific delivery levels, but presently, not every level of ambulatory
care delivery is addressed. Functional areas include: access;
communication; courtesy and respect; shared decision making;
coordination/integration of care; health promotion and education;
customer service and decision support. Some functions are specific to
one delivery level, while others are the shared responsibility of
multiple levels of care. These functions are assessed because they are
necessary in maintaining high quality care, they have been determined
to be important to consumers in selecting health care, and they are
aspects of care for which consumers are the best or only judge.
Background
Since 1995, the only ambulatory CAHPS[reg] survey has
been focused on the health plan level, though there are different
versions across types of plans from fee-for-service through HMOs, as
well as optional modules. Significant stakeholder interest has emerged
in using a standard CAHPS[reg] survey beyond the health plan
level specifically for group practices and clinician-level surveys.
The idea behind ACAHPS is to provide flexible, modular approach to
assessing the quality of ambulatory care at different levels of the
health care system while still retaining the valuable aspects of the
current CAHPS[reg] Health Plan Survey such as industry-wide
standardization of measures for comparability.
Although many combinations of ACAHPS modules are possible, the
CAHPS Consortium plans to simplify the task of constructing a survey by
developing several sets of pre-packaged
[[Page 51314]]
survey instruments and data collection protocols. These surveys will be
designed to address the most common uses based on the market research
completed in 2003 as well as the on-going input from stakeholders. We
will also provide guidelines for reporting the results of these surveys
to external and internal audiences.
In addition, we will design some simple decision trees to help
users assess their needs and recommend a prepackaged survey or help
users to build their own using the ACAHPS modules. Technical assistance
will continue to be offered from the CAHPS-SUN Helpline, 1-800-492-9261
and the Web site located at www.cahps-sun.org.
Dated: August 7, 2004.
Carolyn M. Clancy,
Director.
[FR Doc. 04-18851 Filed 8-17-04; 8:45 am]
BILLING CODE 4160-90-M