With the Hospice CAHPS requirement right around the corner, current FEHC users may be wondering how they can continue using their historical FEHC data. Unfortunately, because so many of the original FEHC questions have been altered for the Hospice CAHPS, a simple fix of mapping one survey instrument to another is not possible. Moreover, while many of the questions on the FEHC are related to questions on the Hospice CAHPS, simply comparing old performance scores to new performance scores may not get you the information that you need to seamlessly continue your improvement efforts.
Why So Many Changes Were Made
When the Hospice CAHPS was being developed, it was based on several survey design principles:
- capture the patient and/or caregiver experience, not the care processes that could be measured by other data sources,
- focus on quality of life related aspects of hospice care such as the NQF preferred practices,
- measure aspects of care that are important to the patient and/or family, and
- contain questions that are under the control of the hospice provider.
Using a technical expert panel on survey research and hospice care quality, and a multitude of interviews with primary caregivers from across the country and from diverse care settings, Hospice CAHPS survey designers used the gathered information to develop the questions with some clear goals in mind:
- clearly identify the time frame of interest for each applicable question,
- highlight the importance of differentiating between questions that asked about the patient’s experiences verses the caregiver’s,
- focus the questions more on what the caregiver needed and less on how much involvement with hospice care actually occurred.
Comparing Hospice CAHPS to FEHC
In a comparison between the FEHC and the Hospice CAHPS, only 8 non-demographic questions contain minor changes in wording which are not expected to affect the results. For these questions, trending historical data to new data is possible. That is, if your agency was receiving an 83% favorable score in Q4 2014 on the FEHC D5: How often did the hospice team keep you informed about the patient's condition? (Always, Usually, Sometimes, Never), assuming nothing drastically has changed in your agency, you could still expect to see about an 83% favorable score on the Hospice CAHPS question 9: While your family member was in hospice care, how often did the hospice team keep you informed about your family member's condition? (Never, Sometimes, Usually, Always) in Q1 of 2015. [Although, in full disclosure true survey methodologists may say that something as little as changing the order of the response options may affect results.] None the less, taking a bit of a less conservative approach, there are a total of 11 FEHC questions, including demographic and parent questions, where differences in Hospice CAHPS question wording or response options should not affect trending: B9, C2, D5, E3, E4, F1, G3, G5, H4, I3, I4.
However, another 16 FEHC questions are related to questions on the Hospice CAHPS but changes to the response options have resulted in an inability to compare old with new, which may leave you wondering what to do with that data. Your first thought may be to use your FEHC score as an internal benchmark to set a target for improvement for the Hospice CAHPS on the related question. For questions that are partially mapped (FEHC: D7, H5, H6, I1) meaning that the questions are worded similarly and some of the FEHC response options are similar to that on the Hospice CAHPS, with some reworking, this may be possible. For example, compare FEHC D7: Would you have wanted more information about what to expect while the patient was dying? (Yes, No) to Hospice CAHPS question 31: Did the hospice team give you as much information as you wanted about what to expect while your family member was dying? (Yes, definitely; Yes somewhat; No). To map the responses, you would need to collapse both Yes categories from Hospice CAHPS question 31 into a single Yes category. You then need to compare the percentage of Yes responses from question 31 to the percentage of No responses from FEHC D7 because D7 asks if you WANTED MORE information while Q31 asks if you received AS MUCH AS YOU WANTED - conceptually opposite.
In the cases where questions are related but both question and/or response option wording is different, using your FEHC score or another national benchmark as a basis for comparison for the related Hospice CAHPS questions, is frankly, just wrong. While the change may seem minor, e.g., the addition of a word or two, the way the caregiver responds to the question may be entirely different. For example, both Hospice CAHPS Q19 and FEHC B3 ask about whether the hospice team provided information regarding pain medicine but the Hospice CAHPS question 19 specifically asks about whether information on a pain medicine’s side effects was received while FEHC B3 refers to any information on pain medicine. Therefore, what may have been a positive response on the FEHC (yes, the caregiver received information on pain medication) may now be answered negatively (no, the caregiver was not given information on the side effects of medication). In fact, the specificity of the Hospice CAHPS question may result in lower performance scores at first until any needed performance improvement projects (PIPs) focusing on medication side effects education are initiated. Thus, comparing performance scores from questions with different interpretations may set you up for failure, not improvement.
So, how can you transition from one survey to the other without feeling like you are starting over?
- Recognize that the lessons learned from doing an experience of care survey will never be lost. The sometimes seemingly painful documentation, generating patient lists, the PIPs, and report reviews have pushed you leaps and bounds beyond your peers who have yet to begin collecting satisfaction data.
- Review Deyta’s Hospice CAHPS & FEHC Data Crosswalk document and note which questions are trendable with little to no work on your part. Continue monitoring those items and setting increasingly more difficult performance goals, if appropriate.
- Review the crosswalk for the questions that can be partially mapped and decide whether to continue trending your results. Remember, if you decide to compare the results of these questions from one survey to the other, you may need to do some mapping work to keep your results comparable.
- Carefully review the questions that are related but not trendable. Note the small differences in wording and decide whether or not any current PIPs need tweaking. Consider whether you expect your Hospice CAHPS performance scores to be higher or lower than the related FEHC question and set your internal goals accordingly.
- Finally, remember that your improvement efforts are not lost. Each and everything that you have done, and will continue to do, has been about delivering quality care and improving the hospice experience. Those efforts are not lost on the patients that you have served and will continue to serve.