Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores

Layla Parast, Ann Haas, Anagha Tolpadi, Marc N. Elliott, Joan Teno, Alan M. Zaslavsky, Rebecca Anhang Price

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Context: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey assesses the care experiences of hospice patients and their families. Public reporting of hospice performance on these survey measures began in February 2018. Objectives: Develop an appropriate case-mix adjustment (CMA) model to allow for fair comparisons between hospices. Methods: We analyzed CAHPS Hospice Survey data reflecting experiences of 915,442 patients who received care from 2513 hospice programs between April 2015 and March 2016. Decedent and caregiver characteristics were identified for inclusion in CMA based on their variation across hospices (as measured by intraclass correlation coefficients [ICCs]) and how predictive they were of responses to survey questions (as assessed by linear regression). Results: The final CMA model included decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, caregiver age, caregiver education, relationship to decedent, survey language/language spoken at home, and response percentile. The characteristics that varied most across hospices were language (ICC = 0.48 for Spanish survey or home language) and payer for hospice care (ICC = 0.42 for Medicare only; ICC = 0.35 for Medicare and private insurance). The characteristics that were most predictive of caregivers' survey responses were payer for hospice care, caregiver education, and survey language/language spoken at home. Lack of appropriate adjustment would incorrectly rank hospices by 1.2–5.4 percentile points. Conclusion: To ensure fair comparisons across hospices, CAHPS Hospice Survey measure scores should be adjusted for several caregiver and decedent characteristics.

Original languageEnglish (US)
Pages (from-to)519-529.e1
JournalJournal of Pain and Symptom Management
Volume56
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Hospices
Health Personnel
Caregivers
Hospice Care
Delivery of Health Care
Language
Risk Adjustment
Medicare
Episode of Care
Education
Social Adjustment
Surveys and Questionnaires
Insurance
Linear Models

Keywords

  • caregivers
  • case-mix adjustment
  • hospice
  • nonresponse
  • Patient experience
  • quality of care

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores. / Parast, Layla; Haas, Ann; Tolpadi, Anagha; Elliott, Marc N.; Teno, Joan; Zaslavsky, Alan M.; Price, Rebecca Anhang.

In: Journal of Pain and Symptom Management, Vol. 56, No. 4, 01.10.2018, p. 519-529.e1.

Research output: Contribution to journalArticle

Parast, Layla ; Haas, Ann ; Tolpadi, Anagha ; Elliott, Marc N. ; Teno, Joan ; Zaslavsky, Alan M. ; Price, Rebecca Anhang. / Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores. In: Journal of Pain and Symptom Management. 2018 ; Vol. 56, No. 4. pp. 519-529.e1.
@article{cbdfb2671eb24faa9d19390de9986bb3,
title = "Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores",
abstract = "Context: The Consumer Assessment of Healthcare Providers and Systems (CAHPS{\circledR}) Hospice Survey assesses the care experiences of hospice patients and their families. Public reporting of hospice performance on these survey measures began in February 2018. Objectives: Develop an appropriate case-mix adjustment (CMA) model to allow for fair comparisons between hospices. Methods: We analyzed CAHPS Hospice Survey data reflecting experiences of 915,442 patients who received care from 2513 hospice programs between April 2015 and March 2016. Decedent and caregiver characteristics were identified for inclusion in CMA based on their variation across hospices (as measured by intraclass correlation coefficients [ICCs]) and how predictive they were of responses to survey questions (as assessed by linear regression). Results: The final CMA model included decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, caregiver age, caregiver education, relationship to decedent, survey language/language spoken at home, and response percentile. The characteristics that varied most across hospices were language (ICC = 0.48 for Spanish survey or home language) and payer for hospice care (ICC = 0.42 for Medicare only; ICC = 0.35 for Medicare and private insurance). The characteristics that were most predictive of caregivers' survey responses were payer for hospice care, caregiver education, and survey language/language spoken at home. Lack of appropriate adjustment would incorrectly rank hospices by 1.2–5.4 percentile points. Conclusion: To ensure fair comparisons across hospices, CAHPS Hospice Survey measure scores should be adjusted for several caregiver and decedent characteristics.",
keywords = "caregivers, case-mix adjustment, hospice, nonresponse, Patient experience, quality of care",
author = "Layla Parast and Ann Haas and Anagha Tolpadi and Elliott, {Marc N.} and Joan Teno and Zaslavsky, {Alan M.} and Price, {Rebecca Anhang}",
year = "2018",
month = "10",
day = "1",
doi = "10.1016/j.jpainsymman.2018.07.014",
language = "English (US)",
volume = "56",
pages = "519--529.e1",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores

AU - Parast, Layla

AU - Haas, Ann

AU - Tolpadi, Anagha

AU - Elliott, Marc N.

AU - Teno, Joan

AU - Zaslavsky, Alan M.

AU - Price, Rebecca Anhang

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Context: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey assesses the care experiences of hospice patients and their families. Public reporting of hospice performance on these survey measures began in February 2018. Objectives: Develop an appropriate case-mix adjustment (CMA) model to allow for fair comparisons between hospices. Methods: We analyzed CAHPS Hospice Survey data reflecting experiences of 915,442 patients who received care from 2513 hospice programs between April 2015 and March 2016. Decedent and caregiver characteristics were identified for inclusion in CMA based on their variation across hospices (as measured by intraclass correlation coefficients [ICCs]) and how predictive they were of responses to survey questions (as assessed by linear regression). Results: The final CMA model included decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, caregiver age, caregiver education, relationship to decedent, survey language/language spoken at home, and response percentile. The characteristics that varied most across hospices were language (ICC = 0.48 for Spanish survey or home language) and payer for hospice care (ICC = 0.42 for Medicare only; ICC = 0.35 for Medicare and private insurance). The characteristics that were most predictive of caregivers' survey responses were payer for hospice care, caregiver education, and survey language/language spoken at home. Lack of appropriate adjustment would incorrectly rank hospices by 1.2–5.4 percentile points. Conclusion: To ensure fair comparisons across hospices, CAHPS Hospice Survey measure scores should be adjusted for several caregiver and decedent characteristics.

AB - Context: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey assesses the care experiences of hospice patients and their families. Public reporting of hospice performance on these survey measures began in February 2018. Objectives: Develop an appropriate case-mix adjustment (CMA) model to allow for fair comparisons between hospices. Methods: We analyzed CAHPS Hospice Survey data reflecting experiences of 915,442 patients who received care from 2513 hospice programs between April 2015 and March 2016. Decedent and caregiver characteristics were identified for inclusion in CMA based on their variation across hospices (as measured by intraclass correlation coefficients [ICCs]) and how predictive they were of responses to survey questions (as assessed by linear regression). Results: The final CMA model included decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, caregiver age, caregiver education, relationship to decedent, survey language/language spoken at home, and response percentile. The characteristics that varied most across hospices were language (ICC = 0.48 for Spanish survey or home language) and payer for hospice care (ICC = 0.42 for Medicare only; ICC = 0.35 for Medicare and private insurance). The characteristics that were most predictive of caregivers' survey responses were payer for hospice care, caregiver education, and survey language/language spoken at home. Lack of appropriate adjustment would incorrectly rank hospices by 1.2–5.4 percentile points. Conclusion: To ensure fair comparisons across hospices, CAHPS Hospice Survey measure scores should be adjusted for several caregiver and decedent characteristics.

KW - caregivers

KW - case-mix adjustment

KW - hospice

KW - nonresponse

KW - Patient experience

KW - quality of care

UR - http://www.scopus.com/inward/record.url?scp=85053080537&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053080537&partnerID=8YFLogxK

U2 - 10.1016/j.jpainsymman.2018.07.014

DO - 10.1016/j.jpainsymman.2018.07.014

M3 - Article

VL - 56

SP - 519-529.e1

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

IS - 4

ER -