The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey.

Background: The Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) Clinician and Group Adult Visit Survey enables patients to report their experiences with outpatient medical offices. Objective: To evaluate the factor structure and reliability of the CAHPS Clinician and Group (CG-CAHPS) Adult Visit Survey. Data Source: Data from 21,318 patients receiving care in 450 clinical practice sites collected from March 2010 to December 2010 were analyzed from the CG-CAHPS Database. Research Design and Participants: Individual level and multilevel confirmatory factor analyses were used to examine CAHPS survey responses at the patient and practice site levels. We also estimated internal consistency reliability and practice site level reliability. Correlations among multi-item composites and correlations between the composites and 2 global rating items were examined. Measures: Scores on CG-CAHPS composites assessing Access to Care, Doctor Communication, Courteous/Helpful Staff, and 2 global ratings of whether one would Recommend their Doctor, and an Overall Doctor Rating. Results: Analyses provide support for the hypothesized 3-factor model assessing Access to Care, Doctor Communication, and Courteous/Helpful Staff. In addition, the internal consistency reliabilities were ≥0.77 and practice site level reliabilities for sites with >4 clinicians were ≥0.75. All composites were positively and significantly correlated with the 2 global rating items, with Doctor Communication having the strongest relationship with the global ratings. Conclusions: The CG-CAHPS Adult Visit Survey has acceptable psychometric properties at the individual level and practice site level. The analyses suggest that the survey items are measuring their intended concepts and yield reliable information.

Background: Data from surveys of patient care experiences are a cornerstone of public reporting and pay-for-performance initiatives. Recently, increasing concerns have been raised about survey response rates and how to promote equity by ensuring that responses represent the perspectives of all patients. Objective: Review evidence on survey administration strategies to improve response rates and representativeness of patient surveys. Research Design: Systematic review adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Study Selection: Forty peer-reviewed randomized experiments of administration protocols for patient experience surveys. Results: Mail administration with telephone follow-up provides a median response rate benefit of 13% compared with mail-only or telephone-only. While surveys administered only by web typically result in lower response rates than those administered by mail or telephone (median difference in response rate: −21%, range: −44%, 0%), the limited evidence for a sequential web-mail-telephone mode suggests a potential response rate benefit over sequential mail-telephone (median: 4%, range: 2%, 5%). Telephone-only and sequential mixed modes including telephone may yield better representation across patient subgroups by age, insurance type, and race/ethnicity. Monetary incentives are associated with large increases in response rates (median increase: 12%, range: 7%, 20%). Conclusions: Sequential mixed-mode administration yields higher patient survey response rates than a single mode. Including telephone in sequential mixed-mode administration improves response among those with historically lower response rates; including web in mixed-mode administration may increase response at lower cost. Other promising strategies to improve response rates include in-person survey administration during hospital discharge, incentives, minimizing survey language complexity, and prenotification before survey administration.

Objectives The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)—a hospital employee patient safety culture survey—and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)—a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related. Methods We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey’s measures using data from 73 hospitals that administered both surveys during similar periods. Results Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P < 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend). Conclusions This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.

Poorly managed hospital discharges and care transitions between health care facilities can cause poor outcomes for both patients and their caregivers. Unfortunately, the usual approach to health care delivery does not support continuity and coordination across the settings of hospital, doctors’ offices, home or nursing homes. Though complex efforts with multiple components can improve patient outcomes and reduce 30-day readmissions, research has not identified which components are necessary. Also we do not know how delivery of core components may need to be adjusted based on patient, caregiver, setting or characteristics of the community, or how system redesign can be accelerated. Project ACHIEVE focuses on diverse Medicare populations such as individuals with multiple chronic diseases, patients with low health literacy/numeracy and limited English proficiency, racial and ethnic minority groups, low-income groups, residents of rural areas, and individuals with disabilities. During the first phase, we will use focus groups to identify the transitional care outcomes and components that matter most to patients and caregivers to inform development and validation of assessment instruments. During the second phase, we will evaluate the comparative effectiveness of multi-component care transitions programs occurring across the U.S. Using a mixed-methods approach for this evaluation, we will study historical (retrospective) and current and future (prospective) groups of patients, caregivers and providers using site visits, surveys, and clinical and claims data. In this natural experiment observational study, we use a fractional factorial study design to specify comparators and estimate the individual and combined effects of key transitional care components. Our study will determine which evidence-based transitional care components and/or clusters most effectively produce patient and caregiver desired outcomes overall and among diverse patient and caregiver populations in different healthcare settings. Using the results, we will develop concrete, actionable recommendations regarding how best to implement these strategies. Finally, this work will provide tools for hospitals, community-based organizations, patients, caregivers, clinicians and other stakeholders to help them make informed decisions about which strategies are most effective and how best to implement them in their communities. Registered as NCT02354482 on clinicaltrials.gov on 1/29/2015