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## Complete Summary

#### TITLE

Behavioral health care patients\' satisfaction: adult patients\' overall
rating of their health plan for counseling or treatment.

#### SOURCE(S)

CAHPS® surveys and tools to advance patient-centered care
\[https://www.cahps.ahrq.gov/default.asp\]. \[internet\]. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); \[updated 2008
Feb 21\]; \[accessed 2004 Apr 15\]. \[3 p\].

ECHO® Survey and Reporting Kit 2004. Rockville (MD): Agency for
Healthcare Research and Quality (AHRQ); 2004. Various p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Patient Experience

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure indicates adult patients\' perceptions of their health plan
for counseling or treatment. Patients rate the health plan on a scale
from 0 to 10, where 0 is the worst plan possible and 10 is the best plan
possible. Responses are grouped by rating: percentages are reported for
ratings of 9 and 10, 7 and 8, and 6 and lower.

**Note**: The percentage of ratings for the group 9 and 10 (or sometimes
8, 9, and 10) is used for consumer-level reporting; higher percentages
indicate better quality. Additionally, frequency distributions
encompassing all groups of ratings (i.e., 9 and 10, 7 and 8, 6 or lower)
are available for plans or providers to use for quality improvement
purposes.

#### RATIONALE

Consumer ratings and reports of their behavioral health care and the
health plan or managed behavioral health care organization (MBHO) that
provide that care are important measures of the quality of behavioral
health treatment. National efforts to develop quality indicators for
behavioral health care by treatment providers, researchers and
policymakers have all included consumer ratings. Moreover, many
behavioral health care treatment providers use consumer ratings as a
component of their quality improvement processes.

The Experience of Care and Health Outcomes (ECHO) Survey is designed to
collect information on patients\' experiences with behavioral health
care. It produces data that can be useful for patients, clinicians,
managed behavioral healthcare organizations (MBHO), health care plans,
purchasers, States, and Federal agencies. This ECHO Survey is part of
the CAHPS family of surveys, which are developed and supported by a
public-private consortium of researchers sponsored by the Agency for
Healthcare Research and Quality (AHRQ).

The ECHO Survey can be used for the following purposes:

-   To satisfy external standards.

-   To improve the quality of mental health and substance abuse
    services.

-   To monitor the quality of behavioral health organizations.

-   To hold providers accountable through public reporting.

#### PRIMARY CLINICAL COMPONENT

Behavioral health care; patients\' experiences; rating of the health
plan for counseling or treatment

#### DENOMINATOR DESCRIPTION

Health plan members age 18 years and older, enrolled in a managed care
organization (MCO) for the previous 12 months with no more than one
break in enrollment of up to 45 days during the enrollment period, who
received behavioral health care services and who answered the \"Overall
Rating of the Health Plan\" question on the Experience of Care and
Health Outcomes (ECHO) Survey

#### NUMERATOR DESCRIPTION

*To report ratings of 9 and 10*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 9 or 10

*To report ratings of 7 and 8*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 7 or 8

*To report ratings of 6 or lower*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 6 or lower

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Eisen SV, Shaul JA, Clarridge B, Nelson D, Spink J, Cleary PD.
Development of a consumer survey for behavioral health services.
Psychiatr Serv1999 Jun;50(6):793-8.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10375149)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Accreditation\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Behavioral Health Care\
Managed Care Plans\
Substance Use Treatment Programs/Centers

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Health plan members age 18 years and older (as of January 1 of the
current year), who have been enrolled in a managed care organization
(MCO) for the previous 12 months with no more than one break in
enrollment of up to 45 days during the enrollment period

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Health plan members age 18 years and older, enrolled in a managed care
organization (MCO) for the previous 12 months with no more than one
break in enrollment of up to 45 days during the enrollment period, who

-   received ambulatory or outpatient and day/night behavioral health
    care services during the evaluation period including outpatient
    visits or treatment sessions, medications, partial treatment, or day
    or night treatment, and

-   answered the \"Overall Rating of the Health Plan\" question on the
    Experience of Care and Health Outcomes (ECHO) Survey.

Include refusals, non-response, and bad addresses/phone numbers.

Refer to the original measure documentation for further details
including administrative codes developed to identify patients who have
received services.

**Exclusions**

-   Deceased

-   Ineligible (not enrolled in the plan)

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Patient Characteristic

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**

*To report ratings of 9 and 10*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 9 or 10

*To report ratings of 7 and 8*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 7 or 8

*To report ratings of 6 or lower*:\
The number of health plan members from the denominator who rated their
health plan for counseling or treatment a 6 or lower

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data and patient survey

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Non-weighted Score/Composite/Scale

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Case-mix adjustment

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

CAHPS recommends adjusting the data for respondent age, education, and
general health status.

If the sample size is sufficient, responses may be analyzed for specific
sub-populations, such as respondents with chronic conditions.

#### STANDARD OF COMPARISON

External comparison at a point in time\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

The ECHO Survey 3.0 is the product of nearly six years of research and
testing, as well as extensive consultations with behavioral health care
experts and consumers.

The ECHO Development Team produced a draft instrument based on the
Consumer Assessment of Behavioral Health Services (CABHS) instrument and
the Mental Health Statistics Improvement Program (MHSIP) survey. The
draft was reviewed by multiple stakeholder groups; it was also evaluated
by survey experts, administrators, mental health providers, and
consumers.

The team conducted literacy testing of the draft instrument as well as
cognitive testing with individuals who received behavioral health care
services. Recommended revisions to the survey based on this testing were
reviewed with the ECHO Development Team to produce the draft of the
survey that was field tested. The current version of the survey tested
at a reading level between 7th and 8th grade.

The team then undertook a field test study to further evaluate the
instrument and to refine it for use as a standardized measure of
behavioral health care.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Daniels AS, Shaul JA, Greenberg P, Cleary PD. The Experience of Care and
Health Outcomes Survey (ECHO): a consumer survey to collect ratings of
treatment, outcomes and plans. In: Maruish ME, editor(s). The use of
psychological testing for treatment planning and outcome assessment. 3rd
ed. Mahwah (NJ): Lawrence Erlbaum Associates; 2004.

ECHO Development Team. Shaul JA, Eisen SV, Clarridge BR, Stringfellow
VL, Fowler FJ Jr, Cleary PD. Experience of care and health outcomes
(ECHO) survey. Field test report: survey evaluation. Rockville (MD):
Agency for Healthcare Research and Quality (AHRQ); 2001 May 8. 100 p.
\[13 references\]

### Identifying Information

#### ORIGINAL TITLE

Overall rating of the health plan for counseling or treatment.

#### MEASURE COLLECTION

[ECHO® Survey
3.0](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=9&doc=4931)

#### MEASURE SET NAME

[ECHO® Survey 3.0 Adult
Questionnaire](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=9&doc=4932)

#### SUBMITTER

Agency for Healthcare Research and Quality

#### DEVELOPER

Agency for Healthcare Research and Quality\
CAHPS Consortium\
Harvard Medical School

#### ENDORSER

National Quality Forum

#### ADAPTATION

Measure was adapted from the Consumer Assessment of Behavioral Health
Services (CABHS) and the Mental Health Statistics Improvement Program
(MHSIP).

#### PARENT MEASURE

Unspecified

#### RELEASE DATE

2002 Feb

#### REVISION DATE

2004 Aug

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

CAHPS® surveys and tools to advance patient-centered care
\[https://www.cahps.ahrq.gov/default.asp\]. \[internet\]. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); \[updated 2008
Feb 21\]; \[accessed 2004 Apr 15\]. \[3 p\].

ECHO® Survey and Reporting Kit 2004. Rockville (MD): Agency for
Healthcare Research and Quality (AHRQ); 2004. Various p.

#### MEASURE AVAILABILITY

The individual measure, \"Overall Rating of the Health Plan for
Counseling or Treatment,\" is published in the \"ECHO Survey and
Reporting Kit 2004.\" This Kit may be downloaded from the [CAHPS Survey
Users Network Web
site](https://www.cahps.ahrq.gov/cahpskit/CAHPSKIT_main.asp).

#### COMPANION DOCUMENTS

The following is available:

-   ECHO - the CAHPS behavioral health survey. \[internet\]. Rockville
    (MD): Agency for Healthcare Research and Quality (AHRQ); 2004
    \[cited 2004 Apr 19\]. Available from the [CAHPS Survey Users
    Network Web
    site](https://www.cahps.ahrq.gov/content/products/ECHO/PROD_ECHO_Intro.asp?p=1021&s=214).

#### NQMC STATUS

This NQMC summary was completed by ECRI on December 13, 2004. The
information was verified by the measure developer on February 11, 2005.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/10/2008