Allen H
Harris Allen Associates, Boston, MA 02116, USA.
Int J Qual Health Care. 1998 Dec;10(6):521-30. doi: 10.1093/intqhc/10.6.521.
To assess guidelines, set by the National Committee for Quality Assurance, for the Health Plan Employer Data and Information Set (HEDIS) 1999 CAHPS 2.0H Survey (formerly the HEDIS 1999 Consumer Survey) in the light of user's needs to monitor health plan performance over time, monitor sick enrollees, and prioritize determinants (drivers) of enrollee experience.
A two-wave, cross-sectional/longitudinal panel design, consisting of national surveys mailed to employees of three major USA corporations in 1993 and 1995.
Samples included employees selected to represent 23 major managed care and indemnity plans in five regions of the USA. In 1993, 14 587 employees responded and in 1995 9018 employees responded (response rates: 51 and 52%). The longitudinal panel sample included 5729 employees who completed both surveys and stayed in the same plan for both years. STUDY MEASURES: The main 1993 and 1995 surveys consisted of 154 and 116 items, respectively. Panel survey content assessed care delivery, plan administration, functional status, well being, and chronic disease.
CAHPS 2.0H's point-in-time, cross-sectional design was unable to detect selection bias and led to an inaccurate view of change in performance. CAHPS 2.0H's use of aggregate samples masked key differences between healthy and sick enrollees; e.g. the sick became less satisfied over time. The association-based, statistical techniques that many survey users will employ to prioritize the 'drivers' of enrollee experience in the absence of CAHPS 2.0H guidelines yielded a less efficient account of change than the multi-method/multi-trait approach developed for this project.
Consumer experience of plan performance is best understood when the separate contributions of longitudinal membership and movement in and out of plans are clarified, changes in health are identified, changes for sick and healthy enrollees are compared, and plan performance on satisfaction criteria is probed to give confirmation and detail. Changes to the CAHPS 2.0H approach in HEDIS 1999 will facilitate user application of these principles.
根据用户长期监测健康计划绩效、监测患病参保者以及确定参保者体验的决定因素（驱动因素）优先级的需求，评估美国国家质量保证委员会制定的《健康计划雇主数据与信息集》（HEDIS）1999年CAHPS 2.0H调查（前身为HEDIS 1999年消费者调查）指南。
采用两波横断面/纵向面板设计，包括1993年和1995年邮寄给美国三大公司员工的全国性调查。
样本包括从美国五个地区被选中以代表23种主要管理式医疗和赔偿计划的员工。1993年，14587名员工做出回应，1995年，9018名员工做出回应（回应率分别为51%和52%）。纵向面板样本包括5729名完成了两次调查且两年都参保同一计划的员工。研究措施：1993年和1995年的主要调查分别包含154项和116项内容。面板调查内容评估了医疗服务提供、计划管理、功能状态、幸福感和慢性病情况。
CAHPS 2.0H的时间点横断面设计无法检测出选择偏差，导致对绩效变化的看法不准确。CAHPS 2.0H使用总体样本掩盖了健康参保者和患病参保者之间的关键差异；例如，随着时间推移，患病参保者的满意度降低。在没有CAHPS 2.0H指南的情况下，许多调查用户将采用基于关联的统计技术来确定参保者体验的“驱动因素”优先级，与为本项目开发的多方法/多特征方法相比，这种方法对变化的解释效率较低。
当明确纵向参保情况以及进出计划的变动的单独贡献、识别健康状况的变化、比较患病和健康参保者的变化，并探究计划在满意度标准方面的绩效以进行确认和细化时，才能最好地理解消费者对计划绩效的体验。1999年HEDEDIS中CAHPS 2.0H方法的改变将促进用户应用这些原则。
