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Physician use of CAHPS® to evaluate and improve the quality of patient communication.

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Arnold GK, Park J, Lynn LA, Hess BJ, Holmboe ES, Lipner RS. — American Board of Internal Medicine

Presented: 12th CAHPS and 2nd SOPS Users Group Meeting12 CAHPS and 2 SOPS Users Group Meeting, April 2010

Issues Addressed: Can feedback from the CAHPS Clinician Survey and a required improvement cycle help individual internists and subspecialists identify patient communication processes that need improvement, and stimulate intervention strategies for practice change?

How the Issues Are Resolved: CAHPS surveys are implemented through the ABIM PIM Practice Improvement Module®, a Web-based self-evaluation tool which requires physicians to complete a practice system survey, adapted from the National Committee on Quality Assurance Physician's Practice Connections program, as well as a performance improvement plan. Physicians complete a PIM to maintain certification.

Changes Made to the CAHPS Survey: Surveys are provided in English or Spanish and are completed anonymously (minimum of 25 responses) using an automated phone or Web system. Physicians are required to plan improvement of one communication process, implement the plan and then re-measure that process using 25 more patients.

Measuring Success: Feedback to the physician includes practice system results and CAHPS items (1= always, 0=otherwise) summarized as proportions. Analyses include frequencies of improvements chosen, test-retest comparisons and performance profiles.

Results: 323 internists and 339 subspecialists completed the PIM with 16,000 CAHPS surveys. Among 28 improvement goals cited, the most common goal was keeping office wait-time within 15 minutes (23% of physicians) with an average baseline rate of 28% (range 0% to 85%) and a re-measurement rate of 67% (39% difference). Other goals (≥10% of physicians) were providing same-day answers to patient questions and patient access for urgent problems. Among internists, encouraging patients to ask questions during office visits (9%); among subspecialists, discussing prescription costs with patients (14%) were popular.

Key Messages: When presented with individual data from CAHPS surveys, physicians can identify and improve relevant communication processes.

Implications for Other Survey Users: Optional use of CAHPS surveys to fulfill a requirement to maintain certification promotes improvement in medical practice settings.

For more information about this presentation, please contact Research@abim.org.