Brown J A, Nederend S E, Hays R D, Short P F, Farley D O
RAND, Santa Monica, CA 90407-2138, USA.
Med Care. 1999 Mar;37(3 Suppl):MS79-88. doi: 10.1097/00005650-199903001-00009.
The authors describe the process used to develop and test survey items targeted to Medicaid consumers for the Consumer Assessment of Health Plans Study (CAHPS). In addition, the authors highlight the special challenges in locating and surveying Medicaid recipients and provide recommendations for increasing response rates.
The RAND CAHPS team reviewed the literature and existing questionnaires to identify health care issues and concepts important to Medicaid consumers. Three focus groups and 66 one-on-one cognitive interviews were conducted to test the relevance of our concepts and items and to identify additional concepts important to Medicaid consumers. After the cognitive interviews, the CAHPS Medicaid consumer survey was field tested using a sample of 930 adults and children receiving both Medicaid and Aid to Families with Dependent Children in Los Angeles County and Oklahoma. To determine if one particular mode were preferable for surveying a Medicaid population, our field test sample was divided randomly into a telephone-mode sample, a mixed-mode sample, and a second telephone-mode sample with enhanced locating procedures. Before finalizing the CAHPS 1.0 surveys, the full CAHPS item set was subjected to a formal literacy review.
The results of the focus groups and cognitive testing informed iterative versions of the list of concepts addressed by the Medicaid-targeted items. Concepts that were not relevant to Medicaid consumers or that consumers were unable to accurately attribute to a health plan were discarded. New concepts addressing important aspects of health care and the health care experience of Medicaid consumers were identified and added. Item wording and format were revised and refined based on the findings from focus groups, cognitive testing, the field test, and the formal literacy review. In the field test, the mixed-mode method achieved the best results with a 56% completion rate.
The testing and formatting efforts described in this article, in combination with a formal literacy review, led to the development of a Medicaid questionnaire that measures the important health care experiences of Medicaid consumers in a format that is "respondent-friendly." Our recommendations for surveying Medicaid recipients can benefit any survey of a Medicaid population.
作者描述了为医疗保健计划消费者评估研究（CAHPS）开发和测试针对医疗补助受益人的调查问卷项目所采用的过程。此外，作者强调了在定位和调查医疗补助领取者方面的特殊挑战，并提出了提高回复率的建议。
兰德CAHPS团队查阅了文献和现有问卷，以确定对医疗补助消费者重要的医疗保健问题和概念。进行了3个焦点小组讨论和66次一对一的认知访谈，以测试我们的概念和项目的相关性，并确定对医疗补助消费者重要的其他概念。认知访谈后，使用洛杉矶县和俄克拉荷马州930名同时领取医疗补助和抚养儿童家庭援助的成年人及儿童样本，对CAHPS医疗补助消费者调查问卷进行了实地测试。为了确定哪种特定方式更适合调查医疗补助人群，我们将实地测试样本随机分为电话调查样本、混合调查样本和采用强化定位程序的第二个电话调查样本。在最终确定CAHPS 1.0调查问卷之前，对整个CAHPS项目集进行了正式的读写能力审查。
焦点小组讨论和认知测试的结果为针对医疗补助项目的项目所涉及的概念列表的迭代版本提供了依据。与医疗补助消费者无关或消费者无法准确归因于医疗保健计划的概念被舍弃。确定并添加了涉及医疗保健重要方面以及医疗补助消费者医疗保健体验的新概念。根据焦点小组讨论、认知测试、实地测试和正式读写能力审查的结果，对项目措辞和格式进行了修订和完善。在实地测试中，混合调查方法取得了最佳效果，完成率为56%。
本文所述的测试和格式化工作，结合正式的读写能力审查，促成了一份医疗补助调查问卷的开发，该问卷以一种“受访者友好”的格式衡量医疗补助消费者重要的医疗保健体验。我们针对调查医疗补助领取者的建议可使任何针对医疗补助人群的调查受益。
