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## Complete Summary

#### TITLE

In-center hemodialysis patients\' satisfaction with care: in-center
hemodialysis patients\' overall ratings of their dialysis center.

#### SOURCE(S)

CAHPS® In-Center Hemodialysis Survey and Reporting Kit 2006. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Oct 17.
various p.

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); \[updated 2008
Feb 21\]; \[accessed 2007 Sep 05\]. \[3 p\].

### 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 is used to assess adult in-center hemodialysis patients\'
perceptions of their dialysis center. Patients rate their dialysis
center on a scale from 0 to 10, where 0 is the worst dialysis center
possible and 10 is the best dialysis center possible. Responses are
grouped by rating: percentages are reported for either ratings of 9 and
10, 7 and 8, and 6 and lower **OR** ratings of 10, 8 and 9, and 7 and
lower.

**Note**: The percentage of ratings for the group 9 and 10 (or sometimes
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 **OR** 10, 8 and
9, and 7 or lower) are available for plans or providers to use for
quality improvement purposes.

#### RATIONALE

As a result of legislation passed in 1972, Medicare pays for more than
two-thirds of the expenditures for care for patients with end-stage
renal disease (ESRD). To help ensure that these patients are receiving
quality care, the Centers for Medicare & Medicaid Services (CMS) has
been reporting comparative clinical information at the facility level
since January of 2001 on its Dialysis Facility Compare Web site.
However, patient survey results are noticeably absent from the current
set of quality measures for ESRD care. In recent years, both the U.S.
Office of the Inspector General and MedPac\'s 2003 Report to Congress
noted the need to evaluate the experience of care for ESRD patients.
Consequently, in late 2002, CMS requested that the Agency for Healthcare
Research and Quality (AHRQ) and the CAHPS grantees produce a patient
survey for in-center hemodialysis patients. This request was part of
CMS\'s broader quality agenda for its ESRD program.

The CAHPS In-Center Hemodialysis Survey is designed to assess the
experiences of hemodialysis patients who receive care from dialysis
facilities. It is intended to serve as a tool that both facilities and
End-Stage Renal Disease Networks can use to measure and improve the
patient-centeredness of their care.

#### PRIMARY CLINICAL COMPONENT

End-stage renal disease (ESRD); in-center hemodialysis; patient reports
on the dialysis center

#### DENOMINATOR DESCRIPTION

In-center hemodialysis patients, age 18 years and older, who answered
the \"Rating of Dialysis Center\" question on the CAHPS In-Center
Hemodialysis Survey (see the related \"Description of Case Finding\" and
the \"Denominator Inclusions/Exclusions\" fields in the Complete
Summary)

#### NUMERATOR DESCRIPTION

In-center hemodialysis patients\' ratings of their dialysis center on a
scale from 0 to 10, where 0 is the worst dialysis center possible and 10
is the best dialysis center possible (see the related \"Numerator
Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

-   Focus groups

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Using the CAHPS in-center hemodialysis survey to improve quality.
Lessons learned from a demonstration project. \[Submitted to the Centers
for Medicare & Medicaid Services by American Insitutes for Research,
RAND, Harvard Medical School, Westat, Network 15. Supported by contracts
1-U18 HS13193-01 and 2-U18 HS09204\]. Rockville (MD): Agency for
Healthcare Quality and Research (AHRQ); 2007. 43 p. \[unpublished\]

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Collaborative inter-organizational quality improvement\
External oversight/Medicare\
Internal quality improvement\
Quality of care research

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Allied Health Personnel\
Dietitians\
Nurses\
Physician Assistants\
Physicians\
Social Workers

#### 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

Living with Illness

#### IOM DOMAIN

Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All currently dialyzing in-center hemodialysis patients, age 18 years
and older, with at least 3 months of experience on hemodialysis at their
current facility

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
In-center hemodialysis patients, age 18 years and older, who answered
the \"Rating of Dialysis Center\" question on the CAHPS In-Center
Hemodialysis Survey. Include refusals, non-responders (never responded,
was unavailable at the time of the survey, was ill or incapable, had a
language barrier, etc.), and bad addresses/phone numbers.

**Exclusions**

-   Deceased

-   Ineligible. The respondent has been a patient at the facility for
    less than three months, is not a patient at the facility, or is no
    longer receiving in-center hemodialysis (received a transplant or
    has switched to peritoneal dialysis).

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
In-center hemodialysis patients\' ratings of their dialysis center on a
scale from 0 to 10, where 0 is the worst dialysis center possible and 10
is the best dialysis center possible

Responses are grouped by rating: percentages are reported for ratings of
9 and 10, 7 and 8, and 6 and lower **OR** 10, 8 and 9, and 7 and lower.
The higher the percentage of ratings for the group 9 and 10 (or 10) is
associated with better quality.

**Note**: Include all completed questionnaires. A questionnaire is
considered complete if responses are available for 12 or more of a
selected list of key CAHPS items. Refer to the original measure
documentation for more information.

**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\
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
self-reported health status.

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Development of the CAHPS In-Center Hemodialysis Survey included:

-   Three rounds of cognitive testing of the draft survey in English and
    Spanish with dialysis patients.

-   Pilot testing with 30 facilities representing different regions and
    unit size.

-   A year-and-a-half-long initiative with seven dialysis facilities and
    four Networks to test the use of the survey as a quality improvement
    tool.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

CAHPS® In-Center Hemodialysis Survey and Reporting Kit 2006. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Oct 17.
various p.

### Identifying Information

#### ORIGINAL TITLE

Rating of dialysis center.

#### MEASURE COLLECTION

[CAHPS In-Center Hemodialysis
Survey](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=9&doc=10541)

#### SUBMITTER

Agency for Healthcare Research and Quality\
Centers for Medicare & Medicaid Services

#### DEVELOPER

Agency for Healthcare Research and Quality\
CAHPS Consortium

#### ENDORSER

National Quality Forum

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

CAHPS® In-Center Hemodialysis Survey and Reporting Kit 2006. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Oct 17.
various p.

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); \[updated 2008
Feb 21\]; \[accessed 2007 Sep 05\]. \[3 p\].

#### MEASURE AVAILABILITY

The individual measure, \"Rating of Dialysis Center,\" is published in
the \"CAHPS In-Center Hemodialysis Survey and Reporting Kit 2006.\" This
Kit may be downloaded at the [CAHPS Survey Users Network Web
site](https://www.cahps.ahrq.gov/cahpskit/CAHPSKIT_main.asp). See the
related
[QualityTools](http://www.innovations.ahrq.gov/content.aspx?id=1936)
summary.

#### COMPANION DOCUMENTS

The following are available:

-   CAHPS user resources. Quality improvement resources. \[Web site\].
    Rockville (MD): Agency for Healthcare Research and Quality (AHRQ);
    \[updated 2007 Dec 10\]; \[accessed 2007 Aug 14\]. Available from
    the [CAHPS Web
    site](https://www.cahps.ahrq.gov/content/resources/QI/RES_QI_Intro.asp?p=103&s=31).

-   CAHPS user resources: project implementation resources. \[Web
    site\]. Rockville (MD): Agency for Healthcare Research and Quality
    (AHRQ); \[updated 2005 Dec 29\]; \[accessed 2007 May 15\]. Available
    from the [CAHPS Web
    site](https://www.cahps.ahrq.gov/content/resources/PM/RES_PM_ProjectImplementation.asp?p=103&s=33).

#### NQMC STATUS

This NQMC summary was completed by ECRI on May 14, 2007. The information
was verified by the measure developer on July 25, 2007.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008