Introduction/Background

The many facets of health care quality

can be divided into two major

categories: one involves the clinical

aspects of care, while the other reflects

patients’ experiences with health care

services. The challenge posed by the

second category is to capture and report

on those experiences in a way that is

meaningful and useful to consumers,

clinicians, and health care

administrators.

The Agency for Healthcare Research

and Quality (AHRQ) has been the lead

Federal Agency in developing and

distributing standardized, evidencebased surveys and related tools for

assessing patients’ experiences with the

U.S. health care system. The Agency’s

Consumer Assessment of Healthcare

Providers and Systems (CAHPS®)

program has become the focal point of

a national effort to measure, report on,

and improve the quality of health care

from the perspective of consumers and

patients.

Overview of the CAHPS

Program

AHRQ launched the CAHPS program

in the mid-1990s. Working with a

national team of public and private

research organizations known as the

CAHPS Consortium, AHRQ

developed and refined a set of

principles that has driven the

development of all CAHPS products:

• Emphasis on actual experience.

While CAHPS surveys include both

ratings and reports of experience,

the emphasis is on respondents’

reports of their experiences with

health care—resulting in

information that is more specific,

actionable, understandable, and

objective than general ratings alone.

• Standardization. Survey tools and

reporting measures are standardized,

which allows for valid comparisons

and benchmarking across health

care settings.

• Use of the best science. The

development of CAHPS surveys

and related tools incorporates the

state-of-the-art in survey and report

CAHPS®: Assessing

Health Care Quality

from the Patient’s

Perspective

P R O G R A M B R I E F

The mission of AHRQ is to improve the quality,

safety, efficiency, and effectiveness of health

care by:

• Using evidence to improve health care.

• Improving health care outcomes through

research.

• Transforming research into practice.

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality
d

esign.Thoroughfieldtesting

ensuresthatsurveyadministration

guidelinesandprotocolsarebased

onsoundevidenceofeffectiveness

andfeasibility.

•Meaningfulinformation.To

ensurethatsurveysgenerate

informationthathasmeaningfor

consumersandotheraudiences,the

CAHPSConsortiumteststhe

languageandformattingofsurvey

instrumentsandreportselements

withvariousaudiencestomaximize

comprehensionandusability.

•Inputfromallaffectedparties.

Thesurveydevelopmentprocess

includesfrequentopportunitiesfor

majorstakeholders,including

clinicians,administrators,and

accreditingbodies,tolearnaboutthe

instrumentandprovidefeedback.

•Publicresource.AllCAHPStools,

resources,andservicesareinthe

publicdomain.Technicalassistance,

includinggeneralguidanceaswellas

project-specificadvice,isavailableto

allusersatnocharge.

Theprogramwasoriginallylaunchedas

theConsumerAssessmentofHealth

PlansStudy.Inthefirst5years,known

asCAHPSI,theConsortiumsucceeded

inbuildinganintegratedsetofcarefully

testedandstandardizedquestionnaires

andreportingformatsforconsumers

enrolledinhealthplans.Consumer

reportingwasamajorfocusofwork

duringthatstageoftheCAHPS

program.

TheAgencybuiltonthatprogresswith

CAHPSII(2002-2007).Duringthat

time,theConsortiumdidthefollowing:

•Conductedresearchanddeveloped

productsthatmeettheneedsof

patientsreceivingcareatvarious

levelsoftheambulatorycaresystem

andfromfacilitiessuchashospitals,

nursinghomes,anddialysiscenters.

•Investigatedwaystoimprovethe

usefulnessandappropriatenessof

CAHPSinstrumentsforvulnerable

populationswithinAmericansociety.

•Exploredavarietyofwaysto

supporttheuseofsurveyresultsto

monitorandimprovequalityofcare.

InJune2007,theAgencylaunched

CAHPSIII.Inthisthirdstage,the

focusoftheCAHPSprogramhas

shiftedfromthedevelopmentofsurveys

tothedevelopmentoftoolsand

resourcestosupporttheuseofCAHPS

surveys.Inadditiontocontinued

refinementofthefamilyofCAHPS

surveys,AHRQhaschargeditsgrantees

todevelopandtestwaysthat

organizationscanuseCAHPSdatafor

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TheCAHPSConsortium

TheCAHPSConsortiumis

comprisedofFederalagenciesand

privateresearchorganizations.

AHRQworkscloselywiththe

CentersforMedicare&Medicaid

Services(CMS),whichhasfunded

thedevelopmentofseveralofthe

CAHPSsurveys.Otheragencies

involvedinCAHPSincludethe

CentersforDiseaseControland

PreventionandtheNationalInstitute

forDisabilityandRehabilitation

Research.

Theprivateresearchersinclude

nationalexpertsinsurvey

development,qualityassessmentand

improvement,andreporting.Inthe

firstgenerationofCAHPS,the

granteeswereHarvardMedical

School,ResearchTriangleInstitute,

andRAND.ForCAHPSII,AHRQ

funded5-yearcooperativeagreements

withtheAmericanInstitutesfor

Research,HarvardMedicalSchool,

andRAND.ForCAHPSIII,the

ConsortiumincludestheYaleSchool

ofPublicHealth(previouslyreferred

toastheHarvardteam)andRAND.

AHRQalsocontractswithWestatto

supporttheworkoftheConsortium

andassistusersofCAHPSproducts

throughtheCAHPSUserNetwork.

WestatalsomanagestheNational

CAHPSBenchmarkingDatabase.
q

ualityimprovementandtodevelop

reportingmethodsthatwillsupport

bothconsumerchoiceandquality

improvementinhealthcare

organizations.

CAHPSFamilyofSurveys

TheCAHPSfamilyofsurveysincludes

instrumentsforassessingthequalityof

careinbothambulatoryand

institutionalsettings.Eachproduct

includesquestionnaires,administration

protocols,analysisprograms,and

guidanceinreportingresults.

SurveysforAmbulatoryCare

CAHPSisbestknownforitsHealth

PlanSurvey,whichhasbecomethe

industrystandardforobtaining

consumers’assessmentsoftheirhealth

plans.TheCAHPSHealthPlanSurvey

isusedbycommercial,Medicaid,State

Children’sHealthInsuranceProgram

(SCHIP),andMedicareplans

representingmorethan120million

enrollees.

Resultsofthesesurveysareusedfor

publicreporting,accreditation,quality

monitoringattheFederalandState

levels,andqualityimprovementatthe

planlevel.TheNationalCommitteefor

QualityAssurance(NCQA)

incorporatesCAHPSresultsintoits

healthplanperformancereportsaswell

asitsaccreditationprocessforhealth

plans.Aversionofthesurveyisalso

usedbyCMS,whichsurveysMedicare

beneficiariesenrolledinmanagedcare

plansaswellasinthetraditional

Medicareprogram,andreportsthe

scoresinapublicWebsite.

DuringCAHPSII,theConsortium

developedsurveysthatassessthe

experiencesofhealthcareconsumersin

variousambulatorysettings,including

physicianoffices,managedbehavioral

healthcareorganizations,dentalplans,

andtribalclinics.Theseinstruments

blendthestandardizationandscientific

rigorthatCAHPSsurveysareknown

forwiththeflexibilityanddepthof

informationthatusershaverequested.

Ambulatorycaresurveyproducts

includecomplete,standardizedsurvey

instrumentsaswellasoptional

supplementalitemsthatmaybeadded

tospecificinstruments.

Formoreinformationaboutthe

CAHPSAmbulatoryCareSurveys,visit

https://www.cahps.ahrq.gov/content/

products/PROD_AmbCareSurveys.asp.

SurveysforFacilityCare

CAHPSproductsincludeseveral

instrumentstoassesspatients’

perspectivesonthecaredeliveredin

healthcarefacilities,suchashospitals,

nursinghomes,anddialysiscenters.

DuringCAHPSII,twofacilitysurveys

werereleasedforpublicuse.The

CAHPSHospitalSurvey,oftenreferred

toasH-CAHPSorHospitalCAHPS,

focusesontheexperiencesofadult

inpatientswithhospitalcareand

services.Hospitalsacrossthecountry

areusingthissurveyandvoluntarily

reportingdatatotheCentersfor

Medicare&MedicaidServices(CMS).

TheCAHPSIn-CenterHemodialysis

Surveyisdesignedtohelpdialysis

facilitiesandEndStageRenalDisease

(ESRD)Networksassessandimprove

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Population-SpecificSurveys

CAHPSsurveyscanbeadaptedfor

specificpopulationswhose

experiencesmaybedifferentfrom

thoseofthegeneralpopulations.

TheHealthPlanSurvey,for

example,includesasetofitemsfor

childrenwithspecialhealthcare

needsaswellasoneforadultswith

mobilityimpairments.

CAHPSsurveysmayalsobeusedto

capturetheexperiencesofaspecific

ethnicorculturalgroup.For

example,incollaborationwiththe

ChoctawNationHealthService,the

Consortiumdevelopedasurveythat

addressestheneedsandexperiences

ofAmericanIndians.
the experiences of patients receiving

hemodialysis.

During CAHPS III, the Consortium

will complete the CAHPS Nursing

Home Surveys, which include

instruments for long-term residents,

recently discharged short-stay residents,

and the families of residents.

For more information on the CAHPS

Facility Surveys, visit

https://www.cahps.ahrq.gov/content/

products/PROD_FacilitiesSurveys.asp.

Resources for Survey Users

AHRQ offers all users of CAHPS

surveys a variety of free services to

guide and support them in

implementing the instruments,

interpreting the results, and using the

information to meet their needs. The

two main vehicles for providing these

services are the CAHPS User Network

and the National CAHPS

Benchmarking Database.

CAHPS User Network

The CAHPS User Network is the

principal source of CAHPS survey

products, information about CAHPSrelated products and services, technical

assistance for survey users, and

networking opportunities for users and

researchers. The User Network is

funded by AHRQ and administered by

Westat.

Through the User Network, users of

CAHPS survey products and results

have access to:

• Free technical assistance. Users

can ask questions through a toll-free

number (800-492-9261) and e-mail

address (cahps1@ahrq.gov).

• A comprehensive, easy-to-use Web

site. The CAHPS Web site

(www.cahps.ahrq.gov) provides

comprehensive information on the

CAHPS program and its products:

• Free product-specific CAHPS

Survey and Reporting Kits, which

include the questionnaires,

reporting measures,

administration protocols,

analysis programs, and

instructions for using the

programs.

• Information about CAHPS

products at various stages of

development and testing.

• Free resources to support the

implementation of a survey

project, the public reporting of

survey results, the use of

CAHPS surveys to improve

quality, and the translation of

CAHPS surveys.

• A searchable FAQ and

bibliography.

• Information and materials

developed for CAHPS events,

including Webcasts and national

User Group Meetings.

• Resources designed to support

users in identifying and

networking with other

organizations that are doing

similar or related work.

• Updates on products and services.

In addition to the Web site, the

CAHPS User Network sends

occasional announcements as well as

The CAHPS Connection to keep

users informed about product

development, upcoming events, and

changes to existing instruments. If

you would like to receive these

updates, subscribe at

https://subscriptions.ahrq.gov/

service/multi_subscribe.html?code=

USAHRQ.

National CAHPS Benchmarking

Database

To enhance the value of a national

standardized survey, AHRQ has worked

closely with Westat to develop the

National CAHPS Benchmarking

Database (CAHPS Database). This

database, which contains over 10 years

of data from commercial and Medicaid

plans, has become the national

repository for data from the CAHPS

Health Plan Survey. In CAHPS III, the

CAHPS Database will develop a

database for the CAHPS Clinician &

Group Survey as well.

The primary purpose of the CAHPS

Database is to facilitate comparisons of

CAHPS survey results by survey

sponsors. Sponsors that participate in

the CAHPS Database can:

• Receive reports that compare survey

results to benchmarks derived from

the database (i.e., reference points

such as national and regional

averages).

• Access data from individual surveys.

• Order customized analyses and

reports on a fee-for-service basis.

The CAHPS Database also offers an

important source of primary data for

specialized research related to consumer

assessments of quality as measured by

CAHPS surveys.

For more information about the

National CAHPS Benchmarking

Database, visit

https://www.cahps.ahrq.gov/content/nc

bd/ncbd_Intro.asp.

For More Information

To learn more about the CAHPS

program and its products and services,

visit www.cahps.ahrq.gov.

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AHRQ Pub. No. 08-PB015

October 2008

Replaces AHRQ Pub. No. 07-P016