Problem-oriented reporting of CAHPS consumer evaluations of health care.

Consumer Assessment of Health Care Providers and Systems (CAHPS) is an organized effort to provide consumers with standardized, comprehensible, and usable data regarding consumers' experiences with health care. In its Medicare and other summary reports, CAHPS emphasizes the frequency of the most positive experiences. Cognitive models of survey response combined with attitude theory suggest that performance measurement might be further improved by the addition of problem-oriented reporting, which highlights the frequency of negative experiences. We propose criteria and use them to assess whether problem-oriented reporting provides valid, precise, and complementary information. Analysis of the 2000 CAHPS Medicare Fee-For-Service and 2001 CAHPS Medicare Advantage survey data shows that problem-oriented reporting (1) is viable, interpretable, and unlikely to represent noise; (2) has statistical power sufficient to capture important differences of magnitudes commonly observed; and (3) provides information that complements standard reporting.