1. Reporting Hospital Quality from the Patient Perspective: Integrating HCAHPS into Hospital Compare David J. Miranda, PhD, CMS Kristin Carman, PhD, AIR Jeanne McGee, PhD, McGee & Evers Consulting, Inc. AcademyHealth Research Meeting Orlando, Florida June 4, 2007

2. Orlando FL, June 4, 2007 ARM2 Outline of Presentation 1. Background 2. Research Questions 3. Methods 4. Results & Discussion

3. Orlando FL, June 4, 2007 ARM3 Background HCAHPS developed 1. By research consortium under grant from Agency for Healthcare Research and Quality (AHRQ) 2. To let patients tell what only they can 3. To inform other patients about what they want to know & should know

4. Orlando FL, June 4, 2007 ARM4 Hospital Compare--Homepage www.hospitalcompare.hhs.gov

5. Orlando FL, June 4, 2007 ARM5

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8. 8 Research Questions (1) How to integrate patient perspectives of care data to a website that currently has very different data? 1. HCAHPS is from patients  Other data is about clinical procedures or outcomes 2. HCAHPS is hospital wide  The other measures are condition- specific

9. Orlando FL, June 4, 2007 ARM9 Research Questions (2) The HCAHPS survey was developed to meet the needs of consumers—so we assumed consumers will be more interested in HCAHPS than clinical How can the public reporting of HCAHPS be used to foster interest in and educate consumers about other aspects of quality (outcomes, standards of care)?

10. Orlando FL, June 4, 2007 ARM10 Research Challenges Can a single website do all this: 1. Interest & educate consumers in quality (including what other patients can tell them about quality) 2. Promote informed healthcare choices 3. Address concerns physicians have about quality measurement and patient survey data, and 4. Provide useful feedback to Hospitals for QI?

11. Orlando FL, June 4, 2007 ARM11 Methods 1. 3 rounds of website audience testing  Three locations  Subjects: MDs, RNs, caregivers & patients 2. Review by Stakeholder workgroup 3. Iterative revisions of mock-ups of displays and text

12. Orlando FL, June 4, 2007 ARM12 Results & Discussion Key Themes: 1. “Clean and quiet” – 1 composite? 2. Patients want to know about their condition 3. Stating who is excluded draws undue attention

13. Orlando FL, June 4, 2007 ARM13 Results & Discussion (continued) Key Themes (continued): 4. MDs: “That’s critical for QI” vs. “It’s too subjective” 5. Once MDs see actual HCAHPS composites or questions, Some recognize its value

14. Orlando FL, June 4, 2007 ARM14 Results & Discussion (continued) Key Themes (continued): 6.Customized sorting might have benefits over static performance-based sorting (“rank ordering”) Default of performance-based sorting helps understanding A high priorities is a print out of all quality data and characteristics of each hospital of interest

15. Orlando FL, June 4, 2007 ARM15 Contact Information David J. Miranda, Ph.D. Social Science Research Analyst CMS Center for Beneficiary Choices 7500 Security Boulevard Woodlawn, MD 21244 410-786-7819 david.miranda@cms.hhs.gov