Venus Patricia J, Rector Thomas S, Shah Mona M
Center for Health Care Policy and Evaluation, Mail Stop MN002-260, 12125 Technology Drive, Eden Prairie, MN 55344, USA.
Am J Manag Care. 2003 Dec;9(12):797-803.
The Consumer Assessment of Health Plans Survey (CAHPS) is widely used to evaluate health plans; however there are few reports of Medicaid health plan efforts to improve performance as measured by CAHPS.
Data from CAHPS were analyzed to help plan administrators determine how they might address member reports of problems obtaining care they or their doctor believed necessary.
Secondary analysis of cross-sectional survey data obtained from adults and children enrolled in 3 Medicaid health plans.
Cross-tabulations of CAHPS responses and follow-up questions asking enrollees to describe the problems they had obtaining care believed necessary.
Problems obtaining care believed necessary were among the most frequently reported problems (13%-17% of adults, 9% of children). Problems obtaining a satisfactory personal doctor; receiving help when calling a physician's office; securing routine, urgent, and specialist care appointments as soon as desired; receiving referrals to specialists; obtaining behavioral health services and prescription medications; and problems with doctor communication were related to problems obtaining care believed necessary. Enrollees' descriptions of the problems corroborated observed relationships between CAHPS responses, and revealed dissatisfaction with doctors' care and lack of coverage for various services as additional contributors.
Analyses of relationships between enrollee-reported problems obtaining care believed necessary and their responses to other CAHPS items and follow-up questions identified a number of plausible causes of this problem. Given the multifaceted nature of problems with obtaining care believed necessary, a plan of action that might substantially improve this predicament was not apparent. Additional information about how health plan operations influence CAHPS results and the effect of health plan interventions on CAHPS measurements are needed to facilitate use of these data for quality improvement.
消费者健康计划评估调查（CAHPS）被广泛用于评估健康计划；然而，关于医疗补助健康计划为提高CAHPS所衡量的绩效而做出努力的报告却很少。
分析CAHPS的数据，以帮助计划管理人员确定如何解决成员关于获得他们或其医生认为必要的医疗服务存在问题的报告。
对从参加3个医疗补助健康计划的成人和儿童中获得的横断面调查数据进行二次分析。
对CAHPS的回答与后续问题进行交叉制表，后续问题要求参与者描述他们在获得认为必要的医疗服务时遇到的问题。
获得认为必要的医疗服务存在问题是最常被报告的问题之一（13%-17%的成年人，9%的儿童）。获得满意的私人医生存在问题；致电医生办公室时获得帮助存在问题；未能尽快获得常规、紧急和专科护理预约存在问题；获得专科转诊存在问题；获得行为健康服务和处方药存在问题；以及医生沟通存在问题，这些都与获得认为必要的医疗服务存在问题相关。参与者对这些问题的描述证实了CAHPS回答之间观察到的关系，并揭示了对医生护理的不满以及各种服务缺乏覆盖范围是其他促成因素。
对参与者报告的获得认为必要的医疗服务存在问题与他们对其他CAHPS项目的回答及后续问题之间的关系进行分析，确定了该问题的一些可能原因。鉴于获得认为必要的医疗服务存在问题具有多方面性质，目前尚不清楚一项可能大幅改善这一困境的行动计划。需要更多关于健康计划运营如何影响CAHPS结果以及健康计划干预对CAHPS测量结果的影响的信息，以便利用这些数据进行质量改进。
