Quality Measurement and Quality Improvement Projects

CAHPS III: Improving Performance of the Indian Healthcare System Using CAHPS as a Measurement Tool

As a subcontractor to Yale University, Sundance Research Institute used a modified CAHPS survey approach to identify opportunities for IHS quality improvement. Two IHS-operated service units, working collaboratively with their respective Tribal health departments and Sundance Research Institute, developed a modified CAHPS survey instrument that retained the core CAHPS measures and added questions reflecting the unique characteristics of IHS services. One service unit designed a targeted quality improvement initiative based on the CAHPS survey results, and the other service unit served as a control site for the project.

The baseline American Indian CAHPS survey was administered in mid-2010 to 400 IHS patients at each site. Regression analysis methods were used to identify the specific dimensions of the care process that had significant association with the overall rating of IHS by patients. This information was used to develop specific quality improvement initiatives focused on customer service, which were implemented in 2011.

Sundance Research Institute staff provided support and assistance to the design of the quality improvement initiatives and monitored ongoing implementation and related activities through site visits and key informant interviews. A follow-up American Indian CAHPS survey was conducted in spring 2012 to assess the impact of the targeted quality improvement initiatives on patient ratings of service unit performance in the targeted dimensions of service and on overall patient satisfaction. Survey results indicated a statistically significant increase in patient ratings of IHS staff courtesy and helpfulness, as well as in overall ratings of IHS services.

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