The Future of Patient Surveys CG- CAHPS E-Mailed

The Future of Patient Surveys? CG- CAHPS E-Mailed vs. Mailed Steven Bergeson MD, Medical Director Quality

© 2009 Allina Health System

Where Is Patient Experience Reporting Headed? Use of CAHPS as Patient Survey Tool Transparency and Public Reporting Pay for Quality Performance

Current trend - Minnesota Year Voluntary or Mandatory Delivery Method 2008 Voluntary Mailed Phone 2009 Voluntary Mailed Phone Handout in Clinic 2010 Voluntary Mailed Phone Handout in Clinic 2011 None 2012 Mandatory Mailed Phone Electronic Statewide reporting since 2008 (MN Community Measurement) for those using a vendor*

AMC CG-CAHPS Results 2008 Access to Care Willing to Recommend MD Communication Rating of MD “ 10” Staff Courtesy Rating of MD “ 9 -10” 1 = Medical group or site was significantly below average 2 = Medical group or site was not significantly above or below average 3 = Medical group or site was significantly above average

Costs Implications: AMC • What is required: Once a year over 3 months, 217 returns per clinic (>3 clinicians) • Mailed surveys cost ~$10 / return (Telephonicmore, Electronic – TBD) AMC est. CG Costs 2011 (3 months) AMC 2010 Survey Budget (12 months) Hospitals (11) H-CAHPS (12 months) $ 94, 5451 $160, 0002 $450, 000 1 Clinic level data 2 Clinician level data

Leadership comments: “We are a poor medical group”. “There will come a day in the when we won’t use the USPS to communicate with our patients. Why are we using a mailed methodology when everything else is electronic? ”

Our Primary Worry • Disenfranchisement: Respondents to paper and electronic surveys will be different – will we be able to use this for QI? Hector P. Rodriguez, MPH et al, Evaluating Patients’ Experiences with Individual Physicians: A Randomized Trial of Mail, Internet, and Interactive Voice Response Telephone Administration of Surveys (Med Care 2006; 44: 167– 174) Results: Response rates were higher by mail (50. 8%) than web (18. 4%) or IVR (34. 7%) In general, respondents using the web were younger (54. 1 vs. 56. 9, P 0. 001), more educated (43. 0% vs. 35. 0% completed college, P 0. 001), had fewer medical conditions (1. 3 vs. 1. 5, P 0. 001), and reported better health status (62. 3 vs. 59. 3, P 0. 001) compared with mail respondents. Mail and web produced identical scores for individual physicians

Mail Based Survey Counts Overall Clinic Sent Valid Returned Surveys Response Rate Buffalo 329 122 37% Coon Rapids 291 150 52% Crossroads Chaska 582 190 33% Eagan 525 165 31% Hastings 461 151 33% Isles 596 225 38% 2784 1003 36% Totals Email Based Survey Counts Clinic Sent Returns Response Rate Buffalo 335 49 15% Coon Rapids 299 56 19% Crossroads Chaska 590 62 11% Eagan 538 60 11% Hastings 469 43 9% Isles 604 111 18% 2835 381 13% Totals

Results: Electronic returns: far faster Returns 1003 377 Mailed CG CAHPS Electronic survey attempts Bounces Opened Unopened 577 4% 22% 74% Response Rate 36% 13%

NS differences for Race, Education, or Self Health Rating

Summary: • Performance of the two modes is promising, detailed analysis pending • We need to increase the response rate to make this viable – Collect e-mails as a part of registration and let pts. know they could get an e-survey – Route survey through a familiar safe address – Fix the clumsiness: One click to enter the survey (No code needed), Don’t let Q 1 be skipped, auto-advance (with a back button) We believe we can make this work