Development of Items to Assess Patients' Health Literacy Experiences at Hospitals for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey

Background: The complexity of health information frequently exceeds patients' skills to understand and use it. Improvement in hospital communication has the potential to improve the quality of care. Objective: To develop a set of items to supplement the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey (HCAHPS) to assess how well hospitals communicate health information to inpatients. Methods: We conducted an environmental scan and obtained input from stakeholders to identify domains and survey items, and cognitively tested the item set in English and Spanish. We administered the items to a random sample of adult hospital patients using mail and telephone data collection. We estimate item-scale correlations for hypothesized multi-item composites, internal consistency reliability for composites, correlations among composites, and regressed global rating of the hospital and a would you recommend the hospital items on HCAHPS existing core and the new composites to evaluate the unique contribution of each to these "bottomline" measures. Results: A total of 1013 surveys were obtained (55% response rate). With some exceptions, correlations between items and scales were consistent with the hypothesized item clusters. Three composites were identified: (1) communication about tests; (2) communication about how to care for self and medicines; and (3) communication about forms. Conclusions: This study provides support for the measurement properties of the HCAHPS Item Set for Addressing Health Literacy. It can serve as both a measure of whether healthcare providers in a hospital setting have communicated effectively with their patients and as a tool for quality improvement.