1. Patient Reports about Health IT Developing & Field Testing Survey Questions for Outpatient Settings Keith McInnes Boston University School of Public Health & VA Bedford Medical Center

2. Outline Background Item Development Illustrative Items Field Testing – Methods – Sample descriptive statistics 2

3. Background Growing use of health IT – Electronic health records – Providers using computers during patient visit – Eprescribing – Patient portals/personal health records Unknown how it affects patient experience of care Interest in developing supplemental items for CAHPS surveys 3

4. Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Standardized surveys to – Assess patient-centered care – Compare and report on performance – Improve quality of care – Patient is the best source of information Supplemental items vs. “core” items Clinician & Group Survey 4

5. Development Process AHRQ stakeholder meeting 2006 Literature review Focus groups Develop item inventory Expert interviews (CIOs, health IT experts, PHR managers) Cognitive interviews Identification of field test sites 5

6. Survey Content Access to Care Core: In the last 12 months when you made an appointment for a check-up or routine care with this doctor, how often did you get an appointment as soon as you thought you needed? Health IT: In the last 12 months, when you used e-mail or a website to get an appointment at this doctor’s office, how often did you get an appointment as soon as you thought you needed? Response Options: Never, Sometimes, Usually, Always 6

7. Survey Content (cont.) Getting Information Core: In the last 12 months, when you phoned this doctor’s office during regular office hours, how often did you get an answer to your medical question the same day? Health IT: In the last 12 months, when you e-mailed this doctor’s office, how often did you get an answer to your medical question as soon as you needed? 7

8. Survey Content (cont.) Prescription Medicines Health IT: In the last 12 months, did you ever use email or a website to ask this doctor’s office to refill or renew one of your prescriptions? 8

9. Survey Content (cont.) Patient use of website or portal Health IT: In the last 12 months, how often were these lab or other test results presented in a way that was easy to understand? (lab results) Health IT: In the last 12 months, how often was the list of prescription medicines up to date?(Eprescribing) Health IT: In the last 12 months, how often were the visit notes easy to understand? (After visit summary) 9

10. Survey Content (cont.) Provider use of computer Health IT: During your visits in the last 12 months, did this doctor ever use a computer or handheld device to show you information? Health IT: During your visits in the last 12 months, did this doctor’s use of a computer or handheld device make it harder or easier for you to talk with him or her? 10

11. Survey Content (cont.) Doctor Communication Core: In the last 12 months, how often did this doctor explain things in a way that was easy to understand? Staff Core: In the last 12 months, how often did clerks and receptionists at this doctor’s office treat you with courtesy and respect? Shared Decision Making Core (supplemental): In the last 12 months, did this doctor talk with you about the pros and cons of each choice for your treatment or your health? 11

12. Field Testing Beth Israel Deaconess Medical Center, Boston Group Health Cooperative, Washington State Kaiser Permanente Southern California 12

13. Field Testing - Overview Beth Israel (BIDMC) Group Health (GHC) Kaiser Permanente (KPSC) Site Description1 Medical Center 9 outpatient clinics 2 Medical Centers Number of MDs selected 192030 Patients per physician 125 120 ModeInternetMailInternet, then Mail Completes (response) 1,115 ( 48%)1,631 (65% )1,896 ( 53%) 13

14. Age and Gender BIDMC (%)GHC (%)KPSC (%) Age 18-34 yrs987 35-44 yrs1499 45-54 yrs241618 55-64 yrs303129 65-74 yrs1723 75 or older614 Female 576257 14

15. Education BIDMC (%)GHC (%)KPSC (%) Less than HS121 HS graduates4911 Some college162637 4-yr college graduate2722 More than 4-yr college534130 15

16. Race / Ethnicity a American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander 16 BIDMC (%)GHC (%)KPSC (%) Hispanic128 Non-Hispanic White928582 Black233 Asian476 Other a 131

17. Health Status – Self-Rating BIDMC (%)GHC (%)KPSC (%) Poor222 Fair9913 Good313634 Very Good403836 Excellent1915 17

18. Acknowledgements AHRQ BIDMC, GHC, KPSC Julie A. Brown Paul D. Cleary Carol Cosenza Lin Ding Patricia Gallagher John Halamka Ron Hays Mimi Hugh Michael Kanter James Ralston Carl Serrato 18