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Abstract: The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys collect standardized information about patient experiences of care from nationally representative samples of people with Medicare to support consumers’ enrollment choices and enable the Centers for Medicare & Medicaid Services to monitor care quality and incentivize high quality patient-centered care. Since 2007, protocols for data collection, analysis, and reporting have evolved to address expanded Medicare coverage options and a shift from a single survey vendor to a model in which health plans hire approved vendors to administer the survey. During that time, response rates for all types of surveys have declined; increasing effort has gone toward increasing survey participation, especially among people whose preferred language is not English. In this paper, we describe the history, goals, and current use of the Medicare CAHPS surveys. We also summarize key methodological issues, such as sample design, field implementation and data cleaning, adjustment, scoring, and report production. Additionally, we discuss issues that may arise more generally in managing a large, annual national survey that has direct impact on policy, and consider how a long-running survey of this nature may need to evolve to reflect changes in health care delivery and promote standardization in survey administration while maintaining survey content.

ObjectivesTo assess the relationship between self-rated mental health (SRMH) and infrequent routine care among Medicare beneficiaries and to investigate the roles of managed care and having a personal doctor.Study designCross-sectional analysis of data from the 2018 Medicare Consumer Assessment of Healthcare Providers and Systems survey.MethodsLogistic regression was used to predict infrequent routine care (having not made an appointment for routine care in the last 6 months) from SRMH, Medicare coverage type (fee-for-service [FFS] vs Medicare Advantage [MA], the managed care version of Medicare), and the interaction of these variables. Models that did and did not include having a personal doctor were compared. All models controlled for demographics and physical health.ResultsOverall, 14.9% of beneficiaries did not make a routine care appointment in the last 6 months, with rates adjusted for demographics and physical health ranging from 14.5% for those with "excellent" SRMH to 19.2% for those with "poor" SRMH. Beneficiaries with poor SRMH were less likely to make a routine care appointment in FFS than in MA (20.1% vs 16.4%, respectively, had not done so in the last 6 months; P

BackgroundPrior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices.ObjectiveEstimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals.DesignMixed-effect regression models in cross-sectional data.Participants2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes.Main measuresCare coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c

ObjectiveSpanish-preferring Medicare beneficiaries are underrepresented in national patient experience surveys. We test a method for improving their representation via higher response rates.Data sources/study setting2009-2010 Medicare CAHPS surveys; Medicare population.Study designWe used surname and address to predict Spanish-language preference for a national sample of 177 139 beneficiaries. We randomized half of the 10 000 non-Puerto Rico beneficiaries with the highest predicted probabilities of Spanish preference (>10 percent) to bilingual mailings (intervention) and half to standard English-only mailings (control).Data collectionMedicare CAHPS Survey data were collected through mail surveys with telephone follow-up of nonrespondents.Principal findingsMail response rate was higher for intervention (28.7 percent) than control (23.9 percent) (P

Surveys often spend substantial money on multiple mailings and telephone calls to ensure high overall response rates and adequate representation of hard-to-reach demographic subgroups. We examine the extent to which an additional mailing and additional sets of telephone calls are effective in attaining these goals across a variety of subgroups in a large, national multimode survey of Medicare beneficiaries. We also examine the relative data quality of the responses that come with each level of extra effort. We find that additional mailings appear more effective in some groups, while additional telephone calls appear more effective in others. Tailoring the fielding strategy differently by subgroup may improve response rates at a lower cost per complete than using the same fielding protocol for all potential respondents, although data quality is likely to decline with additional efforts in either mode.

Purpose: To investigate whether rural‐urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males. Methods: Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban‐rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through evaluation of statistical interactions). Findings: Across all 7 categories of measures, scores for rural residents were worse than scores for urban residents. For 4 categories—care for patients with (suspected) chronic obstructive pulmonary disease, avoiding prescription misuse, behavioral health, and diabetes care—the average difference across measures in the category was greater than 3 percentage points. Across all 34 measures, there were 15 statistically significant rural‐by‐sex interactions that exceeded 1 percentage point. In 11 of those cases, the deficit associated with living in a rural area was greater for males than for females. In 3 cases, the deficit associated with living in a rural area was larger for females than for males. In 1 case involving Follow‐up After Hospitalization for Mental Illness, rural residents had an advantage, and it was larger for males than for females. Conclusions: Interventions may help address patient‐ (eg, health literacy and patient activation), provider‐ (eg, workforce recruitment and retention), and structural‐level issues contributing to these disparities, especially for rural males. [ABSTRACT FROM AUTHOR]

Purpose: The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey, a primarily English-language mail survey with English and Spanish telephone follow-up, is the primary means of assessing the health care experiences of American seniors. We examine unit (whole survey) and item nonresponse for this survey to explore issues regarding surveying seniors about their health care. Design and Methods: We describe overall rates and analyze predictors of unit and item nonresponse for the 695,197 Medicare beneficiaries selected for the 2007 MCAHPS survey (335,249 unit respondents, 49% overall response rate). Results: Asians, African Americans, and Hispanics responded at adjusted response rates 7-17 percentage points lower than non-Hispanic Whites (p less than 0.001 for each). Among seniors, response rates dropped beyond age 75. Asians and older beneficiaries were especially likely to respond by mail, and African Americans and Hispanics by phone. Breakoff from telephone surveys was most common among African Americans and older respondents. Among respondents, older age was the strongest predictor of item missingness (e.g., those 85 years and older failed to answer items at twice the rate of those aged 65-74 years, p less than 0.001). Non-Hispanic Whites had lower rates of item missingness than other racial/ethnic groups (p less than 0.001 for each; one-third lower than African Americans). Implications: Survey research on older adults, especially regarding racial/ethnic disparities in health care, could benefit from improved response rates. These results suggest that targeted prenotification materials and campaigns, tailored follow-up, targeted Spanish mailings, Chinese translations/calls, and adjustments to telephone protocols may improve representation and response.

Objectives: This research explores the relationship between hypothesized protective factors and outcomes for children investigated for maltreatment. Methods: Using data from the National Survey on Child and Adolescent Well-Being (NSCAW), we ran logistic regression models to examine the relationship between hypothesized protective factors (social competence, adaptive functioning skills, and peer relationships) and outcomes (externalizing behavior, internalizing behavior, reading competence). Results: For each hypothesized protective factor, we found variation in individual scores and sample mean scores at the lower end of the scales, indicating that these children fare worse than most children. However, many children experienced large changes in their individual scores over time suggesting that children can and do improve on these hypothesized protective factors. In examining the relationship between hypothesized protective factors and outcomes, children with higher levels of social competence were significantly more likely to be in the normal range for both externalizing and internalizing behaviors. Children with higher mean adaptive functioning skills were more likely to be in the normal range for both externalizing behavior and reading competence. The positive nature of the child's peer relationships was also related to externalizing behavior and reading competence. Conclusions: Overall, our analyses support the idea that social competence, adaptive functioning skills, and peer relationships are related to outcomes for children investigated for maltreatment. While further research is needed to establish a causal link, this work identifies three individual-level hypothesized protective factors as potential sources of variation in outcomes. Practice implications: To prevent or alleviate the harmful consequences maltreatment, it is necessary to understand factors that help children move beyond poor outcomes. Our analyses suggest that a strong relationship exists between a child's social competence, adaptive functioning skills and positive peer relationships and select outcomes three years after being investigated for maltreatment. With these individual-level protective factors related to more positive outcomes, it suggests that intervening to increase protective factors could improve outcomes for maltreated and at-risk children. (Contains 5 tables.)

Understanding the progression of violent and nonviolent criminal activity remains a matter of theoretical debate. In the present study, the authors build on criminological theory and assess the extent to which the progression of violent and nonviolent criminal behaviors follows different trajectories. The authors rely on semiparametric mixture models to examine these comorbidities of offending in a longitudinal sample of delinquent adolescents. The results suggest that the trajectories of violent and nonviolent criminal offending follow similar paths over time and that membership in the chronic violent and nonviolent offender groups are associated with overlapping sets of risk factors. However, the results also indicate that at the individual level, membership in a particular nonviolent offending group does not share high concordance with membership in a particular violent offender group. These findings raise questions about the adequacy of general theories of crime progression and suggest the need to continue investigating behavioral theories that discriminate between different forms of offending. (Contains 3 figures, 8 tables, and 17 notes.)