Development and Evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Survey for In-Center Hemodialysis Patients

Background: The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey. Study Design: We conducted formative research to generate survey questions and performed statistical analyses to evaluate the survey's measurement properties. Setting & Participants: Formative research included focus groups, cognitive interviews, and field testing the survey with dialysis patients. Measurements & Outcomes: We assessed internal consistency reliability (Cronbach alpha) and center-level reliability for 3 multi-item scales. We evaluated construct validity using correlations of the scales with global ratings of the kidney doctor, staff, and dialysis center. Results: Response rate was 46% (1,454 completed surveys). Analyses support 3 multi-item scales: Nephrologists' Communication and Caring (7 items, alpha = 0.89), Quality of Dialysis Center Care and Operations (22 items, alpha = 0.93), and Providing Information to Patients (11 items, alpha = 0.75). The communication scale was correlated the most strongly with the global rating of the "kidney doctor" (r = 0.78). The Dialysis Center Care and Operations scale was correlated most strongly with global ratings of staff (r = 0.75) and the center (r = 0.69). Providing Information to Patients was correlated most strongly with the global rating of the staff (r = 0.41). Limitations: A relatively small number of patients completed the survey in Spanish. Conclusions: This study provides support for the reliability and validity of the CAHPS In-Center Hemodialysis Survey for assessing patient experiences of care at dialysis facilities. The survey can be used to compare care provided at different facilities. (C) 2014 by the National Kidney Foundation, Inc.