RAND Corporation, Santa Monica, California, USA.
RAND Corporation, Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2018 Oct;56(4):519-529.e1. doi: 10.1016/j.jpainsymman.2018.07.014. Epub 2018 Jul 24.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey assesses the care experiences of hospice patients and their families. Public reporting of hospice performance on these survey measures began in February 2018.
Develop an appropriate case-mix adjustment (CMA) model to allow for fair comparisons between hospices.
We analyzed CAHPS Hospice Survey data reflecting experiences of 915,442 patients who received care from 2513 hospice programs between April 2015 and March 2016. Decedent and caregiver characteristics were identified for inclusion in CMA based on their variation across hospices (as measured by intraclass correlation coefficients [ICCs]) and how predictive they were of responses to survey questions (as assessed by linear regression).
The final CMA model included decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, caregiver age, caregiver education, relationship to decedent, survey language/language spoken at home, and response percentile. The characteristics that varied most across hospices were language (ICC = 0.48 for Spanish survey or home language) and payer for hospice care (ICC = 0.42 for Medicare only; ICC = 0.35 for Medicare and private insurance). The characteristics that were most predictive of caregivers' survey responses were payer for hospice care, caregiver education, and survey language/language spoken at home. Lack of appropriate adjustment would incorrectly rank hospices by 1.2-5.4 percentile points.
To ensure fair comparisons across hospices, CAHPS Hospice Survey measure scores should be adjusted for several caregiver and decedent characteristics.
《医疗保健提供者和系统的消费者评估（CAHPS）临终关怀调查》评估了临终关怀患者及其家属的护理体验。自 2018 年 2 月以来，开始对这些调查措施下的临终关怀绩效进行公开报告。
开发适当的病例组合调整（CMA）模型，以实现临终关怀机构之间的公平比较。
我们分析了 2015 年 4 月至 2016 年 3 月期间，2513 家临终关怀计划为 915442 名患者提供护理的 CAHPS 临终关怀调查数据。根据临终关怀机构之间的变化（用组内相关系数[ICC]衡量）和对调查问题的预测能力（用线性回归评估），确定将死者和护理人员特征纳入 CMA。
最终的 CMA 模型包括死者年龄、临终关怀的支付方、主要诊断、临终关怀最后阶段的长度、护理人员年龄、护理人员教育程度、与死者的关系、调查语言/家庭使用的语言以及响应百分位数。在临终关怀机构之间变化最大的特征是语言（西班牙语调查或家庭语言的 ICC 为 0.48）和临终关怀的支付方（仅医疗保险的 ICC 为 0.42；医疗保险和私人保险的 ICC 为 0.35）。对护理人员调查反应最具预测性的特征是临终关怀的支付方、护理人员教育程度和调查语言/家庭使用的语言。如果没有适当的调整，将错误地将临终关怀机构排名提高 1.2-5.4 个百分点。
为确保临终关怀机构之间的公平比较，CAHPS 临终关怀调查测量得分应根据护理人员和死者的几个特征进行调整。
