Surgery News - May 2008 - (Page 12)

S U R G E R Y NEWS • M AY 2 0 0 8 NEWS FROM THE COLLEGE Measuring Patient Experiences of Care B Y E L I Z A B E T H H O Y, M . H . A . atient-centeredness is defined as one of the six dimensions of health care quality in “Crossing the Quality Chasm,” a landmark report published by the Institute of Medicine. But what does patient-centeredness really mean for surgeons and other health care professionals? The dimensions of patient-centered care include (1) respect for patients’ values, preferences, and expressed needs; (2) coordination and integration of care; (3) information, communication, and education; (4) physical comfort; (5) emotional support—relieving fear and anxiety; and (6) involvement of family and friends (Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press: 2001; 40,49). Patient-centered care involves a shared decision-making process and an ability to see the health care system from the patient’s view. Research has shown that increased patient satisfaction is correlated with better clinical outcomes, appropriate use of the health care system, benefits from the services provided, and reduced litigation risk. One way to learn how your patients experience care is through the use of a “patient’s-eye view” of the care system. The Institute for Healthcare Improvement (www.ihi.org) has a free walkthrough tool that is available to medical and surgical practices. This brief questionnaire builds awareness of simple things your organization can do to improve the care process and to enhance the patient experience. However, there are some things only patients can communicate about the quality of the care they receive. One of the most objective and quantifiable P ways to assess patient-centeredness is through patient surveys. Reliable and scientifically valid surveys require the selection of unbiased patients, questions that assess the key dimensions of care, and analysis of results that minimizes bias by including risk adjustment for patient factors. The most widely used surveys of patient experiences of care are the Consumer Assessment of Health Providers and Services (CAHPS) survey instruments. Developed through a public-private partnership of the Agency for Healthcare Research and Quality and researchers at Harvard University, the RAND Corporation, Research Triangle Institute, Westat, and American Institutes for Research, these surveys have been widely adopted by the Centers for Medicare & Medicaid Services, state Medicaid programs, and private health plans. More than 55 million enrollees currently are covered through health plans that rely on CAHPS. The CAHPS surveys focus on provider communication skills, access to care, helpfulness of office staff, and being treated with courtesy and respect. They are extensively field-tested in multiple geographic areas and with broadly representative population samples. They are cognitively tested with respondents to ensure that survey questions are understandable, that the response options available on the survey are appropriate to the experience being measured, and that respondents can accurately answer the questions as written. The CAHPS Consortium has developed a version of the survey designed to measure patient experiences of care at the individual clinician and group practice level. The Clinician and Group CAHPS (CG-CAHPS) questionnaire in- cludes questions about the following dimensions of care in its core item set: Quick access to care. Answers to medical questions by telephone. Coordination of care. Physician communication skills. Health promotion and education. Office staff communication skills. The CG-CAHPS instrument was field tested with multiple specialties. Partners included the Massachusetts Health Quality Partnership and the American Board of Medical Specialties (ABMS). ABMS initiated the working relationship with the CAHPS consortium to establish national benchmarks for performance using a standardized instrument. ABMS intends for CAHPS to be incorporated into the maintenance of certification (MOC) requirements of its boards. However, as the CG-CAHPS questionnaire became public, several surgical specialty societies reviewed the instrument and noted its episodic and procedure-based nature and its omission of questions about informed consent and follow-up care. As a result, the ACS, representing the Surgical Quality Alliance, has contracted with American Institutes for Research (AIR) and Westat to develop a survey to assess patient experiences in surgical care. When the survey is completed in October, it will be submitted to the AHRQ for endorsement as an official CAHPS instrument. The following surgical specialty societies and one surgical board are providing financial support and providing technical input to questionnaire design: American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of Otolaryngology–Head and Neck Surgery American Board of Orthopaedic Surgery American College of Osteopathic Surgeons American College of Surgeons American Society of Anesthesiologists American Society of Colon and Rectal Surgeons American Society of Plastic Surgeons American Urological Association Society of Thoracic Surgeons United Health Foundation These organizations have also recruited surgical practices to field-test the questionnaire, evaluating aspects such as preoperative care, interactions with surgeons and anesthesiologists, postoperative follow-up care, and interactions with surgeons’ office staff. The survey will provide common core questions that can be used for quality improvement within practices, part IV of MOC, and public reporting of quality information for consumer choice. Specialty societies that wish to assess aspects of care unique to their specialty practice will be able develop questions to incorporate in the core survey. Providing the highest-quality surgical care is the core mission of the ACS. The surgical CAHPS questionnaire, when completed, will provide a valuable tool for assessing the degree to which the care individual surgeons provide is patient-centered care. Visit the CAHPS Web site at www.cahps.ahrq.gov/default.asp for more information. MS. HOY is assistant director, Regulatory Affairs and Quality Improvement, Division of Advocacy and Health Policy, ACS. Oweida Scholar Chosen T award is to subsidize attenimothy A. Breon, M.D., dance at the annual Clinical FACS, of Oskaloosa, Iowa, Congress, including has been selected to postgraduate course receive the 2008 fees, in order to help Nizar N. Oweida, young surgeons who M.D., FACS, Scholarare practicing in rurship of the American al communities benCollege of Surgeons. efit from the educaDr. Breon helped to tional experiences establish Iowa Rural the Congress proSurgical Associates, vides.The scholarwhich provides required surgical serDR. TIMOTHY A. BREON, ship is awarded each year by the Executive vices to rural comM.D., FACS Committee of the munities in the Board of Governors. southeastern part of the state. Scholarship requirements are The scholarship was estabavailable at www.facs.org/ lished in 1998 in memory of memberservices/oweida.html. Dr. Oweida, a general surgeon The application deadline for from a small town in western the 2009 Oweida Scholarship is Pennsylvania. Dec. 1, 2008. The purpose of the $5,000 Specialty Reports Now on e-FACS.org ach year, the boards of the 10 surgical specialties recognized by the American Board of Medical Specialties compose reports that are presented to the ACS Board of Regents. The specialty board reports keep Fellows and other interested readers informed of the changes and developments occurring within these groups, specifically the boards of colon and rectal surgery, neurological surgery, obstetrics and gynecology, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, surgery, thoracic surgery, and urology. Previously published in the Bulletin, the reports are accessible via the College’s members-only Web portal at http://efacs.org/ portal/page/portal/ACS_Content/ ACSHOME/HomePagePortlets/ NEWSOURCES/WHATSNEW. ACS COT Given 2007 CDC Injury Prevention Award or its work in alcohol screening and brief intervention activities, the Committee on Trauma (COT) of the ACS has been awarded the 2007 Prevention and Control Health Impact Award, bestowed by the Injury Center at the Centers for Disease Control and Prevention (CDC). The Injury Center recognized the work the COT has done to further the field of injury prevention through communication, collaboration, and programmatic efforts. John Fildes, M.D., FACS, chair of the COT, accepted the award at the annual meeting of the American Public Health Association’s Injury Control and Emergency Health Services Section in Washington, D.C., last fall. http://www.ihi.org http://www.cahps.ahrq.gov/default.asp http://e-FACS.org http://www.facs.org/memberservices/oweida.html http://www.facs.org/memberservices/oweida.html http://efacs.org/portal/page/portal/ACS_Content/ACSHOME/HomePagePortlets/Newsources/whatsnew http://efacs.org/portl/page/portal/ACS_Content/ACSHOME/HomePagePortlets/NEWSOURCES/WHATSNEW http://efacs.org/portl/page/portal/ACS_Content/ACSHOME/HomePagePortlets/NEWSOURCES/WHATSNEW http://efacs.org/portl/page/portal/ACS_Content/ACSHOME/HomePagePortlets/NEWSOURCES/WHATSNEW

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Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

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