NQF endorses HCAHPS patient perception survey

Results will be public and comparable’

The National Quality Forum (NQF), a private, not-for-profit, public benefit corporation in Washington, DC, established in 1999 to standardize health care quality measurement and reporting, has endorsed HCAHPS (Hospital Consumer Assessment of Health Plans), a 27-item survey designed and developed over the past three years by the federal Centers for Medicare & Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ).

The new voluntary consensus standard — representing the consensus of more than 240 health care providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality improvement organizations — is a means to collect and publish meaningful data on how patients view the care they receive in hospitals.

"We considered the HCAHPS survey under expedited review; we did not consider any other survey," says Philip Dunn, NQF’s vice president for communications and public affairs.

"The federal government asked us to do so because it had spent years developing this, and as a final step to get stakeholder input, the government asked us to put this through expedited review," he explains.

The survey includes 22 questions addressing seven domains of hospital care:

  • communication with physicians;
  • communication with nurses;
  • responsiveness of hospital staff;
  • pain control;
  • communication about medicines;
  • cleanliness and quiet of the environment;
  • discharge information.

It also includes five demographic questions (used for patient-mix adjustment and other analytic purposes).

Other specifications include sampling, survey administration, survey and patient-mix adjustment, and reporting.

"As originally submitted to NQF, the survey contained only 25 questions," Dunn notes. "Our steering committee, composed of 20 members across all stakeholder groups, put two back in." The two questions were: "Were you treated with courtesy and respect by your physician?" and "Were you treated with courtesy and respect by your nurse?"

"There was concern among steering committee members that this was a particular area of concern among patients," he explains.

Patients and providers affected

As survey results will be reported publicly, it is anticipated they will be used by consumers in making decisions when choosing a hospital. Such reporting clearly will affect hospital performance as well, according to NQF officials.

"The most commonly cited expected use of HCAHPS by patients would be to help them choose hospitals, because they will have comparable information on what other people think of these hospitals," says Elaine Powers, vice president of programs for NQF.

"I expect, though, that many patients may also use HCAHPS results to actually try to affect their own hospital experiences. For instance, you may go to your local hospital regardless of its HCAHPS results, but if you know that other patients rated the hospital poorly in addressing pain, it might prompt you to have a really detailed conversation with your doctor about how to make sure you get adequate pain control," she continues.

Public and comparable

As for hospitals, Powers continues, "The issue is less about having new information — most hospitals already do some kind of patient surveys in order to inform their internal operations.

"What’s new here is that the results of those surveys are not generally public. The fact that HCAHPS results are both public and comparable across hospitals may cause hospitals to refocus their internal quality improvement efforts, to make sure they’re getting at the aspects of care that HCAHPS evaluates [and consumers will be able to see]," she adds.

Dunn agrees. "The purpose of a standardized survey of this nature is to standardize information across institutions and over time, so consumers and purchasers can accurately gauge how other consumers feel about the health care that they received.

"If Anytown General’ scores well on these surveys, and Anytown Memorial’ across the street does poorly, then residents of Anytown will likely conclude there’s got to be a good reason for that," he explains.

This has implications for quality managers as well, Dunn continues. "Hospitals themselves can use these results for their QI efforts.

"If they notice they are getting poor scores in a certain area, the quality manager can seek to understand why and target their improvement efforts accordingly," he adds.

Dunn says he is not sure about the timeframe for implementation. "What I do know is that a cost-benefit analysis is being done by Abt Associates [of Cambridge, MA], to determine what the financial burden and benefits of collecting HCAHPS survey information will be," he says.

Dunn says he anticipates that ultimately the survey results will be posted at www.hospital compare.hhs.gov, a web site developed by CMS to help consumers compare the quality of care hospitals provide.

Need More Information?

For more information, contact:

  • Philip Dunn, Vice President, Communications and Public Affairs, National Quality Forum, 601 13th St. N.W., Suite 500 North, Washington, DC 20002. Phone: (202) 783-0206. Fax: (202) 783-3434. E-mail: pdunn@qualityforum.org.