The CAHPS Connection: Volume 7, Issue 1
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The Agency for Healthcare Research and Quality's (AHRQ's) CAHPS® Connection is an occasional update for the many users of CAHPS products and survey results. Its purpose is to help you stay informed about new CAHPS products, the product development work of the CAHPS Consortium, and various tools and resources that may be useful to you, such as workshops and educational materials.
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- For previous issues, visit our Web site: https://www.cahps.ahrq.gov.
- To receive e-mails and updates from the CAHPS User Network, subscribe at:
- AHRQ Releases New Patient-Centered Medical Home Item Set for use with the CAHPS Clinician & Group 12-Month Survey
- CAHPS Consortium Finalizes Health Information Technology Item Set
- National Quality Forum Endorses CAHPS Nursing Home Surveys
- New Item Set Supports Assessments of Providers’ Cultural Competence
- Webcast: Measuring Patients' Experiences With Medical Homes Using the CAHPS Patient-Centered Medical Home Item Set
- AHRQ 2011 Annual Conference: Leading Through Innovation & Collaboration
- CAHPS User Network Now Offering Podcasts
- Materials from CAHPS & TalkingQuality Webcasts
- New CAHPS Web Site: Helping You Find What You Need
- Clinician & Group Database Online Reporting System Launched in May 2011
- Next Data Submission Period for Clinician & Group Surveys Begins November 14, 2011
- Clinician & Group Data Files Available for Researchers
- Online Reports for Health Plan Survey Now Available
- Data Submission for the Medical Office Survey on Patient Safety Culture Opened September 15 to October 31
- Webinar Highlights: Using the Medical Office Survey on Patient Safety Culture
AHRQ Releases New Patient-Centered Medical Home Item Set for Use With the CAHPS Clinician & Group 12-Month Survey
As physicians’ offices around the country embrace the concept of the patient-centered medical home (PCMH), it is becoming increasingly important to determine how well the medical home model meets patients’ needs. One way to assess the impact of medical homes is to ask patients directly about their experiences with care.
To better capture experience with the domains of care addressed by medical homes, the Agency for Healthcare Research and Quality’s (AHRQ) CAHPS Consortium has developed and tested an expanded version of the CAHPS Clinician & Group Surveys that combines the 12-Month Survey with a specific set of supplemental items. This new set of items, called the CAHPS PCMH Item Set, covers topics such as provider-patient communication, coordination of care, and shared decisionmaking. A preassembled survey that incorporates the supplemental items into the 12-Month Survey is now available for use by medical practices, health systems, health plans, and others.
Key Features of the Survey for PCMHs
Built on an existing survey. Because the 12-Month Survey remains the foundation of this instrument, users benefit from the standardization and familiarity of the core Clinician & Group Survey. At the same time, they have the flexibility of optional supplemental items that assess additional aspects of care that are increasingly important to medical practices.
Customizable to meet different needs. The 12-Month Survey with PCMH Items can be used to assess patients’ experiences with any primary care practice, not just those that are explicitly functioning as medical homes. Also, in addition to the PCMH supplemental items, users are free to add their own survey items to meet specific information needs.
Developed in accordance with CAHPS principles. The development and testing of the PCMH Item Set was consistent with design principles that emphasize input from consumers and other stakeholders and the use of the best available survey science. Learn about CAHPS Principles.
Chosen for recognition programs. The National Committee for Quality Assurance (NCQA) and others are using this survey for PCMH recognition. See below for more on NCQA’s use of this survey
Available with free resources and support. Like other CAHPS survey products, the PCMH Item Set is in the public domain. It is also accompanied by free instructions and a SAS®-based analysis program to guide survey users through the process of preparing their own questionnaire, selecting a sample, collecting and analyzing the data, and reporting results. AHRQ also offers free access to the CAHPS Help Line at CAHPS1@ahrq.gov or 1-800-492-9261.
Supported by free comparative information. Users of the 12-Month Survey with PCMH Items can submit their data to the CAHPS Database to get access to free comparative information.
Use of the PCMH Survey by National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA) has a recognition program for PCMHs. Included in its standards is an optional patient experience evaluation that can help to qualify a practice for a higher level of recognition. In October 2011, NCQA announced that it is recommending the CAHPS Clinician & Group 12-Month Survey with the PCMH Item Set for this optional standard. Information on this program is available at http://www.ncqa.org/tabid/631/default.aspx.
Learn More About the PCMH Item Set
- Read about the CAHPS Clinician & Group Surveys.
- Read about the CAHPS PCMH Item Set (12-Month Survey with PCMH Items).
- Get Clinician & Group Surveys and Instructions.
CAHPS Consortium Finalizes Health Information Technology Item Set
The CAHPS grantees finalized a new set of supplemental items that ask patients about their experiences with health information technology (health IT) in their doctor’s offices. Examples of health IT include secure electronic communication, electronic medical records, medication refills, access to personal health information, and appointment scheduling. The health IT items, which can be added to the CAHPS Clinician & Group Surveys, will enable survey users to assess the use of health IT from the patients’ perspectives.
Topics Covered by the Health IT Item Set
The items ask about patients’ experiences using these technologies as well as their experiences with providers as they use the technologies. Topics include—
- Helpfulness of information technologies
- Access to and helpfulness of e-mail
- Providers’ use of computers and hand-held devices during visits
Users of these supplemental items can generate new measures of patient experience that complement the existing measures from the Clinician & Group Surveys.
Formatted items with response options and placement instructions are available in Supplemental Items for the Adult Surveys.
- Learn more about the CAHPS Health Information Technology Item Set.
- If you have any questions about this item set, please contact the CAHPS Help Line at CAHPS1@ahrq.gov or 1-800-492-9261.
National Quality Forum Endorses CAHPS Nursing Home Surveys
In March 2011, the three CAHPS Nursing Home Surveys joined the ranks of several other CAHPS surveys in gaining endorsement by the National Quality Forum (NQF). The surveys include—
- CAHPS Long-Stay Resident Survey.
- CAHPS Discharged Resident Survey (This survey’s endorsement is “time-limited,” pending final analyses of reporting composites.)
- CAHPS Family Member Survey.
NQF’s endorsement of these surveys as measures of nursing home quality means that they have met four criteria:1
- Important to measure and report. There is strong evidence that measurement can have a positive impact on health care quality.
- Scientifically acceptable. When implemented, the measure will produce consistent (reliable) and credible (valid) results about the quality of care.
- Usable and relevant. Intended users—consumers, purchasers, providers, and policymakers—can understand the results of the measure and are likely to find them useful for quality improvement and decisionmaking.
- Feasible. Data are readily available for measurement and retrievable without undue burden.
For information about these and other consensus standards for nursing home care, go to: http://www.qualityforum.org/Measures_List.aspx?#k=nursing%2Bhome&p=3&s=n&so=a.
Learn about the CAHPS Nursing Home Surveys.
1 Adapted from “What NQF Endorsement Means.” Available at http://www.qualityforum.org/Measuring_Performance/ABCs/What_NQF_Endorsement_Means.aspx. Accessed June 21, 2011.
New Item Set Supports Assessments of Providers’ Cultural Competence
As of spring 2011, users of the CAHPS Clinician & Group Surveys can incorporate a new set of supplemental items to assess the cultural competence of health care providers from the patient’s perspective. Culturally competent care is defined as care that is responsive to diversity within the patient population and cultural factors that can affect health and health outcomes. The CAHPS Consortium developed the Cultural Competence Item Set to support survey users in identifying and addressing racial and ethnic disparities in patients’ experiences with health care.
The supplemental item set expands on the existing questions about doctor-patient communication in the CAHPS Clinician & Group Surveys.The new items ask patients to report on their experiences with issues such as language access, health literacy, trust, shared decisionmaking, and discrimination.
Development of Cultural Competence Item Set
The Agency for Healthcare Research and Quality (AHRQ) funded the development of the Cultural Competence Item Set with additional support provided through a grant from the Commonwealth Fund.
The development process included the following steps:
- Development of a conceptual model.
- Literature review and environmental scan.
- Development of domains and an initial set of items.
- Translation of item set into Spanish.
- Cognitive testing of items in English and Spanish.
- Field testing.
- Construction of composite measures.
Additional Information & Resources
The items are available in Supplemental Items for the Adult 12-Month Survey in CAHPS Clinician & Group Surveys & Instructions.
Read about the Cultural Competence Item Set.
Listen to a presentation about this item set during the Webcast “Using CAHPS Item Sets that Address Cultural Competence and Health Literacy:”.
Improving Patient Experience Through Health Promotion and Education
This article is based on a case study produced by Shaller Consulting for the Robert Wood Johnson Foundation’s Aligning Forces for Quality program. You can access the full report.
Improving patient experience is a high priority for many medical practices across the country. Several practices are taking the lead on implementing new strategies to improve their patient experience survey scores. One such practice is the Westwood-Mansfield Pediatric Associates (WMPA) near Boston, Massachusetts, which receives scores from the CAHPS-based Ambulatory Care Experiences Survey (ACES) conducted by the Massachusetts Health Quality Partners (MHQP). In response to its scores, Westwood-Mansfield established a goal to improve patient experience specifically within the areas of health promotion and access.
Deciding on a Pressing Issue Within the Practice
Following the Plan-Do-Study-Act (PDSA) model, WMPA chose a specific goal for the clinic: to reduce unnecessary visits for children’s health concerns that parents can manage at home. By addressing this particular issue, the clinic would be better able to focus on more complex chronic conditions such as childhood obesity, rather than on nonurgent, acute conditions.
During the planning process, the practice discovered that a sore throat was the number one reason for a clinic visit. The high volume of these particular visits imposed a major demand on the time of staff and providers.
Implementing a Multifaceted Educational Program
Knowing that approximately 65 to 75 percent of those testing for strep would be negative, WMPA decided to implement a pilot program that encouraged parents to conduct at-home strep tests for their children. The program was composed of several health education strategies, including—
- Postings of educational videos on WMPA’s Web site and YouTube addressing the top health concerns of parents.
- Mailing 2,000 free rapid strep test kits to parents of children aged 6-12 (positive results were repeated in the clinic office).
- Posting of an instructional video on how to perform the at-home strep test.
- Regularly e-mailed educational newsletters about relevant health topics.
Positive Results for Patients and the Practice
As a result of the implementation of these strategies, the clinic observed that appointment slots became more available. This not only helped WMPA meet its goal of increasing visits for more pressing chronic health concerns, it also increased the clinic’s overall revenue. Additionally, the practice saw its ACES score for health promotion rise from 3.5 stars to 4, which helped rank the practice ninth among 169 pediatric practices surveyed by MHQP. Its scores for patients’ willingness to recommend increased from 3 to 4 stars in the same 2-year period (between 2007 and 2009).
Future Efforts to Improve Patient Experience
Looking ahead, WMPA has implemented other initiatives to improve patient experience, specifically within the area of providers’ knowledge of patients. Some of these initiatives include—
- Increasing electronic interactions with patients.
- Adding essential information to each patient’s electronic medical record via a virtual “yellow sticky.” This use of technology allows the provider to better engage with the patient during visits.
To learn more about WMPA’s health promotion and education efforts, visit their Web site: http://www.wmpeds.com
Webcast: Measuring Patients' Experiences With Medical Homes Using the CAHPS Patient-Centered Medical Home Item Set
November 3rd, 2011
The Agency for Healthcare Research and Quality (AHRQ) hosted a free Webcast about the expanded version of the CAHPS Clinician & Group 12-Month Survey with Patient-Centered Medical Home items. Read about this survey in AHRQ Releases New Patient-Centered Medical Home Item Set for Use with the CAHPS Clinician & Group 12-Month Survey in this issue of the Connection.
This Webcast focused on the development, administration, and anticipated uses of this expanded survey. The speakers were—
- Patricia Gallagher, PhD, Senior Research Fellow, Center for Survey Research, University of Massachusetts, Boston; Yale CAHPS Team
- Chris Crofton, PhD, CAHPS Project Officer, Agency for Healthcare Research and Quality (AHRQ)
- David Meyers, M.D. Director, Center for Primary Care, Prevention, and Clinical Partnerships (AHRQ)
- Sarah Scholle, DrPH, Vice President for Research, National Committee for Quality Assurance (NCQA)
- Stephanie Fry (Moderator), Senior Study Director, Westat
To review materials from this Webcast, including slides and recordings, visit the CAHPS Past Events page.
AHRQ 2011 Annual Conference: Leading Through Innovation & Collaboration
The Agency for Healthcare Research and Quality (AHRQ) held its annual conference on September 18–21 at the Bethesda North Marriott Hotel & Conference Center.
Information about this event is available at http://www.capconcorp.com/AHRQ/.
The CAHPS team participated in this year’s annual conference, with information related to CAHPS surveys featured at the following sessions:
Sunday, September 18
1:00 – 4:30 pm: CAHPS Clinician & Group Surveys: Practical Options for Implementation and Use Presentations in this session will include—
- Overview of all CAHPS Surveys
- CAHPS Clinician & Group Surveys: An Introduction to the 2.0 Version
- Implementing the CAHPS Clinician & Group Surveys: Issues and Strategies
- Assessing CAHPS Clinician & Group Survey Results: What the CAHPS Database Can Do for You
- Improving Patients’ Experiences With Primary Care: Resources and Examples including the Patient-Centered Medical Home
- Reporting on Patients’ Experiences with Primary Care: Resources and Examples
Monday, September 19
1:30-3:00 pm: CAHPS Clinician & Group Survey: Comparative Database Results and Use for Quality Improvement
3:30-5:00 pm: CAHPS and Quality: A Close-up of the CAHPS Patient-Centered Medical Home, Cultural Competence, and Health Literacy Item Sets
Tuesday, September 20
12:00-1:00 pm Lunch & Learn Session: CAHPS Survey Updates and Nursing Home Surveys
3:30-5:00 pm: Patient-Centered Medical Homes: The Who, What, and How of Effective Evaluations
3:30-5:00 pm: Patient-Centered Care and Health Information Technology
3:30-5:00 pm: Rewarding Positive Patient Experiences: Incorporating CAHPS in Pay for Performance Strategies
Resources for Users
CAHPS User Network Now Offering Podcasts
In the winter of 2011, the CAHPS User Network posted its first two podcasts as a new resource for CAHPS users. The podcasts complement the collection of Webcasts available in the News and Events section of the CAHPS Web site. The podcasts feature speakers from a variety of organizations around the country who share both their experiences and their professional expertise with the CAHPS User Network.
This fall, the CAHPS team is launching a podcast series on Improving Patients’ Experiences with Care. Each podcast in this series will address issues that are important to improving patients’ experiences, such as cultivating quality improvement leadership, using data tools, and improving provider-patient communication.
The CAHPS site will also link to podcasts on consumer reporting that are being developed for the TalkingQuality Web site. A series on consumer reporting began in May with a podcast on branding quality reports; July’s podcast focused on the criteria used to rate consumer reports on health care quality and September’s podcast talks about using social media to promote awareness and use of quality reports. Users can also find a video podcast that highlights key content and features of the TalkingQuality site.
- To access any of the CAHPS podcasts and materials, visit the .
- To access any of the TalkingQuality podcasts and materials, go to Podcasts & Webinar on the TalkingQuality Web site.
- To get announcements when new podcasts are available, subscribe to the CAHPS list and TalkingQuality lists.
Current CAHPS Podcasts
- Implementing the Clinician & Group Survey in a Community: A Follow-up Chat with Donna Marshall, Executive Director, Colorado Business Group on Health (CBGH), and Thomas Schlesinger, Ph.D., Executive Consultant, Gundersen Lutheran Health System, Wisconsin.
- Assessing Patient-Centered Medical Homes from the Patient’s Perspective: Developing the CAHPS PCMH Survey, a presentation by Susan Edgman-Levitan, Yale CAHPS Team
- Podcast Series – Improving Patients’ Experiences with Care
- The Case for Improving Patient Experience: Dr. Larry Morrissey, Stillwater Medical Group
- Podcast Series – Consumer Reporting
- Branding Your Quality Report: Lisa Mason, Greater Detroit Area Health Council
- Rating the Raters: How the Informed Patient Institute Assesses Health Care Quality Reports, Carol Cronin, Informed Patient Institute
- How Social Media Can Draw Visitors to a Quality Report, Barbara Lambiaso and Lauren Piccolo, Massachusetts Health Quality Partners
Materials from CAHPS & TalkingQuality Webcasts
Materials from the April 5 Webcast on “Using CAHPS Item Sets That Address Cultural Competence and Health Literacy”
In April, the CAHPS team hosted a free Webcast to provide users with more information on how to get the most out of using two supplemental item sets for the Clinician & Group Surveys:
- Questions about providers' efforts to address health literacy.
- Questions to assess the cultural competence of providers.
Several materials from this Webcast are available:
- The slides presented during the Webcast.
- A complete audio recording.
- A complete transcript.
- Responses to participants’ questions that could not be answered during the Webcast.
Access these materials from this past event.
Materials from the May 11th TalkingQuality Webinar on “Who Are You Talking To? New Insights Into the Audience for Consumer Reports on Health Care Quality”
The TalkingQuality Web site hosted a free Webinar on May 11 with guest speakers Patrick McCabe, a partner at GYMR Public Relations in Washington, DC, and Jeff Rabkin, president of Wowza Inc. in Minneapolis, MN. The speakers discussed the kinds of people who are interested in quality reports, how and when they seek health care information, and what this means for report developers.
Several materials from this Webinar are available:
- A video replay of the Webinar.
- A complete audio recording.
- The slides presented during the Webinar.
- A complete transcript.
Access these materials at https://cahps.ahrq.gov/news-and-events/podcasts/podcasts.html.
New CAHPS Web Site: Helping You Find What You Need
The Agency for Healthcare Research and Quality (AHRQ) has launched a redesigned CAHPS site to improve the ability of users to find the information they need about CAHPS surveys and related products. The site offers efficient one-click access to information about specific CAHPS surveys and makes it easier to get to important related information, such as instructions for using those surveys.
Features of the New Site
The main content of the site focuses on the various CAHPS surveys and ways to use those surveys to improve patient experience and inform consumers. In addition, the CAHPS site retains improved versions of existing features, such as—
- Comparative data for the Health Plan Surveys and the Clinician & Group Surveys.
- A searchable bibliography.
- Frequently asked questions.
- Recordings of Webcasts.
- Copies of slides presented at national meetings.
- Archived news and CAHPS Connection articles.
One new feature on the site is a growing collection of podcasts, where you can hear directly from survey users and experts about a variety of topics, including strategies for improving provider-patient communication and tips on branding a quality report for consumers. To learn more about our new podcasts, read CAHPS User Network Now Offering Podcasts in this issue of the Connection.
We Were Listening
The changes are a direct response to feedback that the CAHPS User Network has received from users of the CAHPS Web site. Users’ responses to the Web-based survey on the CAHPS site have been invaluable in helping us pinpoint areas in which we could improve the navigation, structure, and content of the site.
Feedback from users also informed a redesign of the pages where users can download for free the actual CAHPS surveys, analysis programs, and instructions. This page is now offered for every survey, so that you can easily see what documentation is available. We have also made it easier to identify exactly what you want to view or download to your computer.
We’re Still Listening
The CAHPS User Network welcomes your comments on the new site. Please let us know about any positive or negative experiences by contacting us at CAHPS1@ahrq.gov or 1-800-492-9261.
CAHPS Database news
This section of The CAHPS Connection provides updates on the activities and products of the CAHPS Database.
Clinician & Group Database Online Reporting System Launched in May 2011
In May 2011, the CAHPS Database released new comparative data for the CAHPS Clinician & Group Survey (CG-CAHPS) through the Online Reporting System: https://www.cahpsdatabase.ahrq.gov.
Results are available for both the 12-Month and Visit versions of the Clinician & Group Surveys. Key features of the CG-CAHPS Online Reporting System include—
- Top box scores display the percentage of survey respondents who chose the most positive response option for composite measures, ratings, and individual question items.
- Frequencies (one-way or two-way) show the distribution of scores for all response options and allow users to run custom displays by respondent and practice site characteristics.
- Bar charts display a graphical distribution of the top, bottom, and middle response categories of survey results.
- Percentiles display the percentage of practice sites that scored at or below a particular top box score.
- Report Builder allows users to create custom downloadable reports.
All survey users that follow CAHPS survey specifications are welcome to participate in the CAHPS Database at no charge. In return for submitting their own data, participants have authorized access to a secure, password-protected Submitter’s Site. This site allows submitting organizations to view their own results compared to relevant benchmarks to identify performance strengths as well as opportunities for improvement.
Next Data Submission Period for Clinician & Group Surveys Begins November 14, 2011
The next opportunity for users of the CAHPS Clinician & Group Surveys to submit data through the CAHPS Database Online Submission System will begin November 14, 2011. The system will be available for submission of the three versions of the CAHPS Clinician & Group Survey:
- 12-Month Survey
- Visit Survey
- 12-Month Survey with Patient-Centered Medical Home (PCMH) Items
Comparative results will be posted in April 2012.
Information regarding data specifications and other submission requirements are available on the submission system home page.
A training video presenting step-by-step instructions for submission is currently available for downloading.
Clinician & Group Data Files Available for Researchers
Research files based on the 2010 CAHPS Clinician & Group Survey data presented in the Online Reporting System in May are now available. Individuals interested in obtaining these files should contact the CAHPS Database.
Online Reports for Health Plan Survey Now Available
The 2011 Health Plan Survey results were posted in late September on the CAHPS Database's Online Reporting System, available at http://www.cahpsdatabase.ahrq.gov.
The reporting system presents national summary-level results for the commercial, Medicaid, CHIP, and Medicare sectors for the years 2011 and 2010. Users will be able to select specific composites or questions to view and build their own reports. As in previous years, a fixed format version of the report will be available for downloading.
Individual results for Medicaid and CHIP survey users that contributed data in 2011 are available through the secure, password-protected area of the online system, allowing them to view their own results compared to selected benchmarks. Individual users will be notified when their results are ready.
CAHPS Database Contact Information
Spotlight: AHRQ Surveys on Patient Safety Culture (SOPS)
This spotlight focuses on the program activities and products of the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture (SOPS). AHRQ sponsors both CAHPS and SOPS as part of its portfolio of surveys to measure and drive improvements in the quality and safety of health care. To learn more about SOPS, visit http://www.ahrq.gov/qual/patientsafetyculture or e-mail questions to firstname.lastname@example.org.
Data Submission for the Medical Office Survey on Patient Safety Culture Opened September 15 to October 31
AHRQ invited users of the Medical Office Survey on Patient Safety Culture (Medical Office SOPS) to submit data to a new comparative database modeled after the Hospital and Nursing Home SOPS Comparative Databases. This new database will enable medical offices to compare their survey results with other medical offices across the country.
Participation was open to all medical offices in the United States or its territories that administered the AHRQ Medical Office SOPS and were willing to voluntarily submit data to this new database. AHRQ will use the data to produce a comparative database report similar to the 2011 Hospital Comparative Database Report. Until the first comparative database report is released by AHRQ in spring 2012, medical offices can compare to the 2010 Preliminary Comparative Results.
- For more information about data submission, visit http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2011/mosubinfo.html.
- E-mail questions to DatabasesOnSafetyCulture@ahrq.hhs.gov or call 1-888-324-9790.
Webinar Highlights: Using the Medical Office Survey on Patient Safety Culture
On April 29, 2011, the Agency for Healthcare Research and Quality (AHRQ) sponsored a Webinar on “Using the Medical Office Survey on Patient Safety Culture.” Participants heard an overview of the development and use of the survey. In addition, the Oregon Practice-based Research Network shared lessons learned from a large implementation of the survey. Speakers presented results from 470 medical offices as reported in the 2010 Preliminary Comparative Results and findings from new analyses examining:
- Differences in patient safety culture perceptions between physicians and other medical office staff.
- The relationship of medical office characteristics like size, ownership, specialty, and health IT implementation to the survey results.
Materials from the Webinar, including the presentation slides, a transcript, and a full replay, are available at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/index.html.
More Information on SOPS
- For more details about the SOPS program, including copies of the surveys and toolkit materials, visit http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html.
- For questions about the SOPS surveys or technical assistance, e-mail SafetyCultureSurveys@ahrq.hhs.gov.
- For questions about the SOPS comparative databases or data submission, e-mail DatabasesOnSafetyCulture@ahrq.hhs.gov.
comments or questions about CAHPS?
The CAHPS User Network welcomes your comments and questions. Please contact us:
- E-mail: email@example.com
- Phone: 1-800-492-9261
Internet Citation: The CAHPS® Connection. AHRQ Publication No. 11-CAHPS003-EF, Volume 7, Issue 1, October 2011. Agency for Healthcare Research and Quality, Rockville, MD.
AHRQ Pub. No. 11-CAHPS003-EF