Consumer Voices Matter

07 May 2014
In February 2014, the Washington Health Alliance released the results of its second patient experience survey, which measures patients’ experiences with local primary care providers. Known as Your Voice Matters, this initiative offers important insights to understanding the quality of care in the region. The Alliance is the only organization in Washington State to have systematically asked patients about their primary care experience and made comparable results publicly available.
Patient experience refers to what happens to people when they are interacting with the health care system and seeking to have their needs met. Patient experience surveys ask patients whether or not or how often certain events happened and not simply the patients’ expectations and feelings, which can be highly subjective. Research shows that, in addition to being a factor that is highly valued by patients and their families, patient experience is also positively correlated with improved clinical outcomes.
“Before AF4Q encouraged the Alliance to undertake this work, patient experience was not a topic of serious discussion in our region,” said Susie Dade, deputy director for the Alliance. “These survey results have elevated the awareness of patient experience as a critical component of care for both providers and consumers.”
The Alliance survey was based on the nationally recognized Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician & Group 12-Month Survey, also known as the CG-CAHPS Survey. CAHPS was created by the federal Agency for Healthcare Research and Quality (AHRQ) and has undergone rigorous scientific development and testing to ensure validity and reliability.
The Alliance’s survey includes 52 questions (including all of the core CG-CAHPS questions plus supplemental questions in areas of interest) asking patients to report their experiences with the health care provider and the provider’s office staff over the past 12 months. By using a nationally developed, standardized survey, the Alliance is not only able to compare results locally but also to benchmark those results against best practices nationwide.
The survey results are summarized in four categories: getting timely appointments, care, and information; how well providers communicate with patients; helpful, courteous, and respectful office staff; and the patient’s overall rating of the provider. The performance results reflect the “top box” score—that is, the percentage of patients whose responses indicate high performance for a given measure. The Alliance reports the top box rate for two important reasons:
  • The Alliance vision is that providers will achieve 90th percentile performance and place among the best in the county. By reporting top box results for each medical group and clinic, the Alliance aims to establish excellence as the standard.
  • Top box rates are easy to explain. Focus group testing indicates that consumers understand what the results mean. Top box reporting is more effective in helping consumers to identify providers with whom patients most often have the best patient experience.
The results from this survey, which was fielded by the Center for the Study of Special Services (CSS) on behalf of the Alliance, include both good and bad news. The good news is that the Alliance added Medicaid patients to its patient sample, sending the survey to one-third more patients than it did previously in 2011-2012. The survey had an overall response rate of 29 percent, or about 33,000 patients, enabling robust results for 46 medical groups and 185 clinic locations. Moreover, one of the four categories—how helpful and respectful the medical group’s office staff is—saw a statistically significant improvement from 71.9 percent in the first report to 73.9 percent in the second. In addition, several clinics saw improvement in their results, highlighting that change for the better is indeed possible.
Unfortunately, not all the news was good. Patients report the best performance overall in the category of how well providers communicate with them, with a regional average of 80.1 percent saying “always,” a small but statistically significant decline from the 80.9 percent in 2012. The percentage of patients who rated their provider a 9 or 10 on a scale of 0 to 10 declined to 74.6 percent, a statistically significant drop from 75.4 percent in 2012.
While these results are somewhat disappointing, they do provide important information for both patients and providers. Without seeing how they compare to their peers, providers would have no way to gauge how well they are doing and where they need to improve.
And, while patient experience is already important, it is possibly becoming more important as patients become better-informed consumers of their health care and as patient experience results are increasingly tied to provider payment. Your Voice Matters gives patients trustworthy data based on feedback from thousands of patients, empowering them to make good decisions about their health care.