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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Health plan members' experiences: percentage of adult health plan members who reported how often they get care quickly.
Source(s)
CAHPS® health plan survey and reporting kit 2008. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Jan. various p.

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Patient Experience
Secondary Measure Domain
Clinical Quality Measure: Access

Brief Abstract

Description

This measure is used to assess the percentage of respondents who indicated how often ("Never," "Sometimes," "Usually," or "Always") they:

  • Got care as soon as they needed when they were sick or injured
  • Got an appointment as soon as they needed when they weren't sick or injured

The "Getting Care Quickly" composite measure is based on two questions in the CAHPS Health Plan Survey 4.0 (Adult Questionnaire).

Note: A composite score is calculated in which a higher score indicates better quality. Composite scores are intended for consumer-level reporting. Additionally, frequency distributions are available for plans or providers to use for quality improvement purposes.

Rationale

The Agency for Healthcare Research and Quality (AHRQ) (then called the Agency for Health Care Policy and Research, or AHCPR) initiated the CAHPS program in October 1995 to develop standardized survey tools for obtaining and reporting information on consumers' experiences with health care. The CAHPS consortium began by developing the CAHPS Health Plan Survey, an integrated set of carefully tested and standardized questionnaires and report formats that can be used to produce meaningful, reliable, and comparable information about the experiences of consumers enrolled in health plans.

The CAHPS Health Plan Survey is designed to generate information that consumers can use to choose health plans, that purchasers can use to assess the value of services they buy, and that health plans can use to assess their performance and improve their products and services. As AHRQ had intended, the survey can be used with all types of health insurance consumers--including Medicaid recipients, Medicare beneficiaries, and those who are commercially insured--and across the full range of health care delivery systems, from fee-for-service to managed care plans. The instruments also capture information about special groups, including individuals with chronic conditions and disabilities and families with children.

The National Committee for Quality Assurance (NCQA) requires health plans to submit measures from the CAHPS Health Plan Survey as part of their HEDIS submission and for accreditation purposes.

Evidence for Rationale
Severyn Group. Personal communication. 2004 Apr 9.  13 p.
Primary Health Components

Health care; members' experience; getting care quickly

Denominator Description

Health plan members age 18 years and older who answered the "Getting Care Quickly" questions on the CAHPS Health Plan Survey 4.0 (Adult Questionnaire) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of "Never," "Sometimes," "Usually," or "Always" responses on the "Getting Care Quickly" questions (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure

Refer to the 2008 CAHPS Health Plan Survey Chartbook for the distribution of the CAHPS Health Plan Survey scores for each of the four composite measures and the individual items that make up each of the composites.

Evidence for Additional Information Supporting Need for the Measure
What consumers say about the quality of their health plans and medical care: The National CAHPS Benchmarking Database. CAHPS health plan survey chartbook. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Oct. 43 p.
Extent of Measure Testing

The CAHPS Health Plan Survey has probably been tested more completely than any previously used consumer survey.

There are two different and complementary approaches to assessing the reliability and validity of a questionnaire (1) cognitive testing, which bases its assessments on feedback from interviews with people who are asked to react to the survey questions, and (2) psychometric testing, which bases its assessments on the analysis of data collected by using the questionnaire. Although many existing consumer questionnaires about health care have been tested primarily or exclusively using a psychometric approach, the CAHPS team views the combination of cognitive and psychometric approaches as essential to producing the best possible survey instruments. Consequently, both methods have been included in the development of the CAHPS survey.

The cognitive testing method provided useful information on respondents' perceptions of the response task, how respondents recalled and reported events, and how they interpreted specified reference periods. It also helped identify words that could be used to describe health care providers accurately and consistently across a range of consumers (e.g., commercially insured, Medicaid, fee-for-service, managed care, lower socioeconomic status [SES], middle SES, low literacy, higher literacy) and helped explore whether key words and concepts included in the core questions worked equally well in both English and Spanish.

The CAHPS consortium also tested each CAHPS reporting composite in focus groups with plan members. Cognitive interviews with consumers were conducted to ensure that the reporting composites and their labels were easily understood. Psychometric analyses using data collected during pilot tests were also conducted. These analyses indicated that both the composites and the items in each composite were reliable and valid measures of members' experiences. In addition, items in each reporting composite were tested and found to be internally consistent. For example, reliability coefficients (Cronbach's alpha) in one pilot test involving four health plans using the instrument that most resembled the final CAHPS 2.0 instrument ranged from a low of 0.68 for the "Getting Needed Care" composite to a high of 0.90 for the "How Well Doctors Communicate" composite. These composites are positively associated with members' ratings of overall care provided by doctors and nurses and ratings of health plans.

In addition, the CAHPS development team, together with researchers from the National Committee on Quality Assurance (NCQA), conducted a detailed comparative analysis of the items in the CAHPS questionnaire and NCQA's Member Satisfaction Survey (MSS) from the fall of 1997 to the spring of 1998. These questionnaires were merged to form the 2.0 version of the CAHPS questionnaire. This testing is noteworthy because it was so extensive and because of the wide array of techniques used. These included focus groups, in-depth cognitive testing, pilot studies, methodological experiments, and large demonstration studies, such as the demonstrations in Washington State, Kansas, and New Jersey. NCQA also worked with the CAHPS consortium to conduct field tests of the 4.0 instrument with six health plans in spring 2005.

Evidence for Extent of Measure Testing
CAHPS®: Surveys and tools to advance patient-centered care [https://www.cahps.ahrq.gov/default.asp]. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2008 Feb 21]; [accessed 2007 Sep 05]. [3 p].

State of Use of the Measure

State of Use
Current routine use
Current Use
Accreditation
Decision-making by businesses about health plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Department of Defense/TRICARE
External oversight/Medicaid
External oversight/Medicare
External oversight/State government program
Internal quality improvement
National reporting
Quality of care research

Application of the Measure in its Current Use

Measurement Setting
Managed Care Plans
Professionals Involved in Delivery of Health Services
Does not apply to this measure (e.g., measure is not provider specific)
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Specified
Target Population Age

Age greater than or equal to 18 years

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Health and Well-being of Communities
Person- and Family-centered Care

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
End of Life Care
Getting Better
Living with Illness
Staying Healthy
IOM Domain
Patient-centeredness
Timeliness

Data Collection for the Measure

Case Finding Period
  • 12 months or longer (commercial)
  • 6 months or longer (Medicaid)
Denominator Sampling Frame
Enrollees or beneficiaries
Denominator (Index) Event or Characteristic
Encounter
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Time window brackets index event
Denominator Inclusions/Exclusions

Inclusions
Health plan members age 18 years and older who have been enrolled in:

  • The commercial plan for 12 months or longer, with no more than one 45-day break in enrollment during the 12 months

    OR

  • A Medicaid plan or product for 6 months or longer, with no more than one 30-day break in enrollment during the 6 months.

AND

Who answered the "Getting Care Quickly" questions on the CAHPS Health Plan Survey 4.0 (Adult Questionnaire). Include refusals, non-response, and bad addresses/phone numbers.

Exclusions

  • Individuals with coverage other than primary health coverage, such as dental-only plan
  • Deceased
  • Ineligible (not enrolled in the plan)
Exclusions/Exceptions
Does not apply to this measure
Numerator Inclusions/Exclusions

Inclusions
The number of "Never," "Sometimes," "Usually," or "Always" responses on the "Getting Care Quickly" questions

From the responses, a composite score is calculated in which a higher score indicates better quality.

Note: Include all completed questionnaires. A questionnaire is considered complete if responses are available for 10 or more of a selected list of key CAHPS items. Refer to the original measure documentation for more information.

Exclusions
Unspecified

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Patient/Individual survey
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

CAHPS® Health Plan Survey 4.0, Adult Questionnaire

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Composite/Scale
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Analysis by subgroup (stratification by individual factors, geographic factors, etc.)
Case-mix adjustment
Description of Allowance for Patient or Population Factors

CAHPS recommends adjusting the data for respondent age, education, and general health status.

If the sample size is sufficient, responses may be analyzed for specific sub-populations, such as respondents with chronic conditions.

Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison

Identifying Information

Original Title

Getting care quickly.

Measure Collection Name
Submitter
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
Developer
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
CAHPS Consortium - Health Care Quality Collaboration
Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]
Funding Source(s)

Agency for Healthcare Research and Quality (AHRQ)

Composition of the Group that Developed the Measure
  • Agency for Healthcare Research and Quality (AHRQ)
  • American Institutes for Research (AIR)
  • Harvard Medical School
  • National Committee for Quality Assurance
  • RAND
  • Westat
Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser
National Quality Forum
NQF Number
0006
Date of Endorsement

2007 Jul 1

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2009 Jan
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: CAHPS® health plan survey and reporting kit 2007. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Nov 14. Various p.

The measure developer reaffirmed the currency of this measure in November 2013.

Source(s)
CAHPS® health plan survey and reporting kit 2008. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Jan. various p.
Measure Availability

The individual measure, "Getting Care Quickly," is published in the "CAHPS® Health Plan Survey and Reporting Kit 2008." This Kit may be downloaded at the CAHPS Web site External Web Site Policy.

For more information, contact CAHPS Technical Assistance.

Companion Documents

The following are available:

  • What consumers say about the quality of their health plans and medical care: The National CAHPS Benchmarking Database. CAHPS health plan survey chartbook. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Oct. 43 p.
  • CAHPS® user resources: project management resources. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2008 Oct 29]; [accessed 2009 Mar 17]. [2 pages].
  • The health care report card compendium. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2011 Oct 26]; [accessed 2012 Jan 20]. [1 page]. Available from the CAHPS Web site External Web Site Policy.
  • CAHPS® survey and reporting kits. Project profiles. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2008 Oct 29]; [accessed 2009 Mar 17]. [2 pages].
  • CAHPS® survey and reporting kits. Reporting resources: downloadable documents. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2009 Apr 23]; [accessed 2009 Mar 17]. [2 pages].
  • The CAHPS Improvement Guide.[internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [updated 2011 Nov 4]; [accessed 2012 Jan 20]. [1 page]. This document is available in (PDF) from the CAHPS Web site External Web Site Policy.

For more information, contact CAHPS Technical Assistance.

NQMC Status

This NQMC summary was completed by ECRI on April 24, 2007. The information was verified by the measure developer on June 15, 2007.

This NQMC summary was updated by ECRI Institute on May 18, 2009. The information was verified by the measure developer on August 14, 2009.

This NQMC summary was retrofitted into the new template on April 29, 2011.

The information was reaffirmed by the measure developer on November 5, 2013.

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