Adelphi Real World Ltd., Bollington, Cheshire, United Kingdom;
Amgen, Inc., Thousand Oaks, California; and.
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1099-108. doi: 10.2215/CJN.10121013. Epub 2014 May 15.
The US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were drawn from the Adelphi CKD Disease Specific Program (a retrospective, cross-sectional survey of nephrologists and patients). Selected United States-based nephrologists treating patients receiving hemodialysis completed patient record forms and provided information on their dialysis center. Patients (n=404) completed the CAHPS-ICH survey (comprising 58 questions) providing six scores for the assessment of patient experience of care. CAHPS-ICH item-scale convergence, discrimination, and reliability were evaluated for multi-item scales. Floor and ceiling effects were estimated for all six scores. Patient (demographics, dialysis history, vascular access method) and facility characteristics (size, ratio of patients-to-physicians, nurses, and technicians) associated with the CAHPS-ICH scores were also evaluated.
Item-scale correlations and internal consistency reliability estimates provided support for the nephrologists' communication (range, 0.16-0.71; α=0.81) and quality of care (range, 0.16-0.76; α=0.90) composites. However, the patient information composite had low internal consistency reliability (α=0.55). Provider-to-patient ratios (range, 2.37 for facilities with >36 patients per physician to 2.8 for those with <8 patients per physician) and time spent in the waiting room (3.44 for >15 minutes of waiting time to 3.75 for 5 to <10 minutes) were characteristics most consistently related to patients' perceptions of dialysis care.
CAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.
美国医疗保险和医疗补助服务中心（CMS）终末期肾病前瞻性支付系统和质量激励计划要求透析中心满足患者护理质量的预定义标准，以确保未来的资金。CMS 选择了医疗保健提供者和系统中心血液透析患者评估（CAHPS-ICH）调查来评估患者的护理体验。本分析评估了 CAHPS-ICH 调查在血液透析患者样本中的心理测量特性。
设计、地点、参与者和测量：数据来自 Adelphi CKD 疾病特定计划（对肾病医生和患者进行的回顾性、横断面调查）。选择的美国肾病医生治疗接受血液透析的患者完成了患者记录表，并提供了有关其透析中心的信息。患者（n=404）完成了 CAHPS-ICH 调查（由 58 个问题组成），提供了 6 个用于评估患者护理体验的分数。评估了多项目量表的 CAHPS-ICH 项目量表收敛性、区分度和可靠性。还估计了所有 6 个分数的地板和天花板效应。还评估了与 CAHPS-ICH 评分相关的患者（人口统计学、透析史、血管通路方法）和设施特征（大小、患者与医生、护士和技术人员的比例）。
项目量表相关性和内部一致性可靠性估计为肾病医生的沟通（范围，0.16-0.71；α=0.81）和护理质量（范围，0.16-0.76；α=0.90）综合提供了支持。然而，患者信息综合的内部一致性可靠性较低（α=0.55）。提供者与患者的比例（范围，每医生 36 名以上患者的设施为 2.37，每医生 8 名以下患者的设施为 2.8）和在候诊室等待的时间（等待时间超过 15 分钟为 3.44，等待时间为 5 至<10 分钟为 3.75）是与患者对透析护理的看法最一致相关的特征。
CAHPS-ICH 是评估患者对透析护理体验的有价值和信息丰富的工具。需要进一步研究以估计护理提供者之间的临床有意义差异。
