Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences.

BACKGROUND: To complement a nursing home resident survey, the team developed a survey asking family members about their experiences with nursing homes. Although a family member does not receive care directly from a nursing home, their experiences at the nursing home and with staff can contribute to understanding nursing home quality. OBJECTIVES: To describe how the nursing home family member instrument was developed, refined, tested, and finalized. RESEARCH DESIGN: The team developed a draft survey using information from a literature review, 12 focus groups with family members involved in choosing a nursing home for someone, review of nursing home surveys, and expert/stakeholder input. The survey went through 2 rounds of cognitive interviews (n=54) and revisions and was fielded in 15 nursing homes. Data from the pilot survey (n=885) were subjected to psychometric analyses to evaluate the measurement properties of items as well as the reliability and validity of the resulting composites. On the basis of these analyses and input from experts, the survey was finalized. RESULTS: Focus groups and experts provided input into discerning important indicators of quality, although in some cases family members were not the best sources of information. Cognitive testing refined the survey and eliminated some of the proxy items. The field test analysis and input from experts eliminated 10 items. The final survey included 21 items organized into 4 composites. CONCLUSIONS: This survey measures family members' experiences of nursing home care, and the results contribute to the understanding of quality of care in nursing homes.

Development of the Consumer Assessment of Pharmacy Services survey.

OBJECTIVES: To develop and test a tool for obtaining patient evaluations of the quality of pharmacy services provided in ambulatory settings. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: United States from June 1, 2006, through May 31, 2007. PARTICIPANTS: 895 individuals who obtained prescription medications from participating pharmacies. INTERVENTION: Items were evaluated for inclusion in composite scales based on factor analysis and frequency of missing data. Standard psychometric methods were used to assess the reliability and construct validity of the resulting three composite and three global-item measures. MAIN OUTCOME MEASURE: Patient assessment of the quality of ambulatory care pharmacy services. RESULTS: Confirmatory factor analysis indicated that a subset of 15 items measuring three aspects of pharmacy services (General Staff Communication, Health- and Medication-Focused Communication, and Clarity of Written Information about Medications) provided excellent fit to the data. Cronbach's alphas for these scales were greater than 0.80. The three scales and corresponding three global ratings of quality reliably described differences among providers of pharmacy services. CONCLUSION: These data provide support for the reliability and validity of the Consumer Assessment of Pharmacy Services survey. Although preliminary results regarding reliability and validity are promising, further study of the survey is warranted.

The "choose with care system" - development of education materials to support informed Medicare health plan choices.

People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices. Choose with Care is an innovative decision support tool for employers to use to assist people approaching age 65 to learn about their Medicare health plan options and how to incorporate information on the quality of care and services offered by health plans into their choices. Employers are the targeted channel for distributing the Choose with Care materials because they are one of the most recognized and accessible formal intermediaries for information about health insurance. We used multiple methods to test the Choose with Care products. Product testing showed that the Choose with Care materials increase older consumers' knowledge of Medicare and how it relates to retiree health insurance and improves their comprehension and use of comparative quality information when choosing a health plan.