Layla Parast1, Ann Haas2, Anagha Tolpadi3, Marc N Elliott3, Joan Teno4, Alan M Zaslavsky5, Rebecca Anhang Price6. 1. RAND Corporation, Santa Monica, California, USA. Electronic address: parast@rand.org. 2. RAND Corporation, Pittsburgh, Pennsylvania, USA. 3. RAND Corporation, Santa Monica, California, USA. 4. Oregon Health & Science University, Portland, Oregon, USA. 5. Harvard Medical School, Boston, Massachusetts, USA. 6. RAND Corporation, Arlington, Virginia, USA.
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.
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.
Authors: Layla Parast; Anagha A Tolpadi; Joan M Teno; Marc N Elliott; Rebecca Anhang Price Journal: J Gen Intern Med Date: 2021-01-19 Impact factor: 5.128
Authors: Maria DeYoreo; Rebecca Anhang Price; Cheryl K Montemayor; Anagha Tolpadi; Melissa Bradley; Danielle Schlang; Joan M Teno; Paul D Cleary; Marc N Elliott Journal: J Palliat Med Date: 2022-01-21 Impact factor: 2.947
Authors: Veerawat Phongtankuel; M C Reid; Sara J Czaja; Jeanne Teresi; Joseph P Eimicke; Jian X Kong; Holly Prigerson; Ariel Shalev; Ritchell Dignam; Rosemary Baughn; Ronald D Adelman Journal: Palliat Med Rep Date: 2020-07-07