2938 Federal Register / Vol. 80, No. 13 / Wednesday, January 21, 2015 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Notice of Proposed Changes for the 

Consumer Assessment of Healthcare 

Providers and Systems (CAHPS) 

Clinician & Group Survey 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of request for public 

comments. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) seeks 

comments on proposed changes to the 

CAHPS Clinician & Group (CG–CAHPS) 

Survey, including the Patient-Centered 

Medical Home (PCMH) Item Set. The 

CG–CAHPS survey is a product of the 

CAHPS program, which is funded and 

administered by AHRQ. AHRQ works 

closely with a consortium of public and 

private research organizations to 

develop and maintain surveys and tools 

to advance patient-centered care. AHRQ 

proposes these revisions in order to 

enhance the survey usability and 

functionality. AHRQ will implement 

these changes and release a new version 

of the CG–CAHPS Survey, Version 3.0. 

in 2015. 

DATES: AHRQ encourages submission of 

comments via email because postal mail 

addressed to AHRQ is subject to delay 

due to security screening. Please submit 

email comments to: CAHPS1@

westat.com and write ‘‘CAHPS Proposed 

Changes’’ on the subject line. 

If filing comments on paper, write 

‘‘CAHPS Proposed Changes’’ on the 

comments and on the envelope, and 

mail them to: Christine Crofton, Ph.D., 

AHRQ CAHPS Program Director, Center 

for Quality Improvement and Patient 

Safety, Agency for Healthcare Research 

and Quality, 540 Gaither Road, 

Rockville, MD 20850. 

Comments on this notice must be 

received no later than 5 p.m. EST on 

February 20, 2015. AHRQ will remove 

all commenter identifying information 

from the comments and will not provide 

individual responses. AHRQ will 

provide a summary of the comments 

and actions taken as a result of those 

comments. The summary document will 

be posted on the AHRQ CAHPS Web 

site https://cahps.ahrq.gov/index.html 

no later than 45 days after the closing 

of the comment period. 

FOR FURTHER INFORMATION CONTACT: 

Christine Crofton, Ph.D., AHRQ CAHPS 

Program Director, Center for Quality 

Improvement and Patient Safety, 

Agency for Healthcare Research and 

Quality, 540 Gaither Road, Rockville, 

MD 20850, Email: Christine.Crofton@

AHRQ.hhs.gov, Phone: (301) 427–1323. 

ADDRESSES: Information about the 

CAHPS Program—including background 

information, surveys, and tools—can be 

found on the AHRQ CAHPS Web site at 

https://cahps.ahrq.gov/index.html. 

SUPPLEMENTARY INFORMATION: 

Background 

Through its CAHPS program, AHRQ 

has been advancing the research and 

practice of patient-centered care 

(CAHPS® is a registered trademark of 

the Agency for Healthcare Research and 

Quality). The goals of the CAHPS 

program are: (1) To develop 

standardized surveys that organizations 

can use to collect comparable 

information on patients’ experiences 

with care, and (2) to generate tools and 

resources to support the dissemination 

and use of comparative survey results to 

inform the public about and improve 

health care quality. The CAHPS®

surveys assess quality of care from the 

patient point of view in their use of 

health plans as well as various 

ambulatory and institutional settings, 

including physician practices, hospitals, 

and nursing homes. The surveys address 

a range of health care services and 

provide results that address the various 

needs of health care consumers, 

purchasers, health plans developers, 

providers, and policymakers. 

The CAHPS Consortium—which 

includes two AHRQ grantees (RAND 

Corporation and Yale School of Public 

Health), Westat (a support contractor), 

and AHRQ staff—are responsible for the 

research and development work 

necessary to produce CAHPS 

instruments, survey protocols, analysis 

tools, and reporting guidance. The 

consortium plays a critical role in 

educating and supporting organizations 

that use CAHPS products and data. 

Proposed Changes 

AHRQ is proposing changes to the 

CG–CAHPS Core Survey, including the 

PCMH Item Set. These proposals are 

based on feedback from survey users 

and other stakeholders. 

The following principles have guided 

the changes to the survey and item set: 

(a) Minimizing the burden of surveys on 

patients and providers and to ensure 

consistency across multiple mandates 

for patient experience surveying by 

developing a single core survey; (b) 

balancing suggestions to shorten the 

survey with requests to add content— 

such as a measure of care 

coordination—while retaining the core 

topic areas of access, communication, 

office staff interactions, and a provider 

rating; and (c) maximizing the reliability 

of the CG–CAHPS reporting measures 

by grounding all recommended changes 

in analyses of relevant data. The 

proposed changes aim to balance the 

importance of the measures to patients 

and stakeholders with the reliability and 

validity of the measures. 

Listed below is an overview of the 

proposed changes to the CG–CAHPS 

Survey, including the PCMH Item Set. 

Further details about the specific 

changes by composite measure and at 

the item level can be found on the 

AHRQ CAHPS Web site at: https://

cahps.ahrq.gov/surveys-guidance/cg/

about/proposed-cg-update.html. 

Changes to CG–CAHPS Survey 

Survey reference time period: AHRQ 

proposes changing the reference time 

period of the CG–CAHPS Survey from 

‘‘In the last 12 months’’ to ‘‘In the last 

six months.’’ Rationale: This change 

will make the survey consistent with the 

survey versions being implemented by 

the Centers for Medicare & Medicaid 

Services (CMS), including the ACO 

CAHPS Survey and the CAHPS Survey 

for the Physician Quality Reporting 

System (PQRS). A study that 

randomized patients to a 12-month or 6- 

month survey version yielded similar 

CAHPS scores at the practice site level. 

Access composite measure: AHRQ 

proposes reducing the number of items 

in this composite measure from five 

items to three items: ‘‘Got urgent care 

appointment’’, ‘‘Got appointment for 

checkup or routine care’’, and ‘‘Got 

answer to medical question the same 

day.’’ Rationale: These items are 

important to patients and stakeholders, 

have good reliability, and include 

multiple aspects of access. 

Communication composite measure: 

AHRQ proposes reducing the number of 

items in this composite measure from 

six items to four items: ‘‘Explains things 

in a way that is easy to understand’’, 

‘‘Listens carefully’’, ‘‘Shows respect for 

what you have to say’’, and ‘‘Spends 

enough time.’’ Rationale: The proposed 

four-item composite is consistent with 

the communication measure in the 

CAHPS Health Plan Survey. 

Care Coordination composite 

measure: Care coordination is an 

important aspect of patient experience 

that is commonly assessed by CAHPS 

surveys. The goal was to develop a care 

coordination composite measure that 

could be standardized across CAHPS 

surveys. According to an article by Ron 

D. Hays et al, the CAHPS Medicare 

Survey includes a 10-item measure, but 

a shorter measure may make 

standardization more likely. The full 


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Federal Register / Vol. 80, No. 13 / Wednesday, January 21, 2015 / Notices 2939 

article published in 2013 in Medical 

Care Research and Review is available at 

http://www.ncbi.nlm.nih.gov/pmc/

articles/PMC3959996/. Given the 

importance of care coordination for 

stakeholders and patients, AHRQ 

proposes to add a composite measure to 

the CG–CAHPS core survey. Since two 

of the items are already part of the core 

survey, this new composite requires the 

addition of only one item to the core 

survey. 

The new three-item care coordination 

composite would consist of ‘‘Follow up 

on test results’’ (from the CG–CAHPS 

core survey), ‘‘Knows important 

information about medical history’’ 

(from the CG–CAHPS core survey), and 

‘‘Provider talked about all prescription 

medicines being taken’’ (from the PCMH 

Item Set). 

With these changes, including the 

addition of the care coordination 

measure, the final core CG–CAHPS 

Survey will be reduced from 34 items to 

31 items. 

Patient-Centered Medical Home 

(PCMH) Item Set 

The PCMH Item Set is a collection of 

supplemental items that ask about 

experiences with the domains of a 

medical home. The combination of the 

core CG–CAHPS Survey with the PCMH 

Item Set constitutes the CAHPS PCMH 

Survey. The PCMH Survey has been 

used by the National Committee for 

Quality Assurance (NCQA) as part of its 

PCMH Recognition Program (see below, 

Related Efforts). AHRQ proposes the 

following changes to the PCMH Item 

Set. 

Shared decision making: AHRQ 

proposes moving three items to the 

general set of supplemental items. 

Rationale: The items require large 

sample sizes to achieve acceptable unitlevel reliability. 

Self-management support: AHRQ 

proposes retaining two items. Rationale: 

While reliability estimates were mixed 

for different data sets, stakeholders have 

deemed these items critical to PCMH 

Item Set. 

Attention to mental or emotional 

health: AHRQ proposes retaining one 

item ‘‘Things that cause worry or stress’’ 

and moving the other two items— 

‘‘Depression screening’’ and ‘‘Personal 

or family problems’’—to the general set 

of supplemental items. Rationale: AHRQ 

agrees with NCQA’s view that three 

items are not necessary to capture 

comprehensiveness. The retained item 

is most correlated with the overall 

composite. 

Information on getting care on 

evenings, weekends, and holidays: 

AHRQ proposes retaining this item, 

which is also regarded by NCQA’s 

stakeholders as critical for inclusion for 

PCMH Item Set. 

Getting care on evenings, weekends, 

and holidays: AHRQ proposes moving 

this item to the general set of 

supplemental items. Rationale: The 

number of responses in most practicebased surveys is insufficient to achieve 

reliability. 

Days wait for urgent care: AHRQ 

proposes moving this item to the general 

set of supplemental items. Rationale: 

AHRQ supports NCQA’s proposal 

regarding this item. 

Reminders between visits: AHRQ 

proposes moving this item to the general 

set of supplemental items. Rationale: 

AHRQ supports NCQA’s proposal 

regarding this item. 

Care coordination items: The PCMH 

Item Set includes two items related to 

care coordination. These items did not 

combine to form a composite measure. 

As noted above, AHRQ proposes 

moving the item ‘‘Provider talked about 

all the prescription medicines being 

taken’’ into the core survey for the new 

measure of care coordination. AHRQ 

also proposes changing the current, 

‘‘Yes-No response’’, scale for this item to 

a, ‘‘Never/Sometimes/Usually/Always’’ 

frequency response, scale. The second 

item, ‘‘Provider informed and up-to-date 

on care from specialists’’ would remain 

in the PCMH Item Set. 

Related Efforts 

AHRQ has been working closely with 

the CMS, our Federal partner in the 

CAHPS Consortium, throughout this 

process to achieve alignment with the 

CAHPS Survey for ACOs and the 

CAHPS for PQRS Survey. For specific 

questions about these surveys, contact 

the ACO CAHPS team at acocahps@

hcqis.org or 1–855–472–4746 or the 

PQRS CAHPS team at pqrscahps@

hcqis.org. 

As noted, NCQA currently uses the 

CAHPS PCMH Survey as part of its 

PCMH Recognition Program. NCQA has 

issued a separate proposal for changes 

to the survey that may be used for the 

PCMH program in the future. For 

specific questions about the use of the 

PCMH Survey by NCQA, contact their 

customer support at (888) 275–7585 or 

customersupport@ncqa.org. 

Dated: January 13, 2015. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2015–00767 Filed 1–20–15; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Scientific Information Request on 

Imaging for Pretreatment Staging of 

Small Cell Lung Cancer 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Request for scientific 

information submissions. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is seeking 

scientific information submissions from 

the public. Scientific information is 

being solicited to inform our review of 

Imaging for Pretreatment Staging of 

Small Cell Lung Cancer, which is 

currently being conducted by the 

AHRQ’s Evidence-based Practice 

Centers (EPC) Programs. Access to 

published and unpublished pertinent 

scientific information will improve the 

quality of this review. AHRQ is 

conducting this systematic review 

pursuant to Section 902(a) of the Public 

Health Service Act, 42 U.S.C. 299a(a). 

DATES: Submission Deadline on or 

before February 20, 2015. 

ADDRESSES: 

Online submissions: http:// 

effectivehealthcare.AHRQ.gov/

index.cfm/submit-scientificinformation-packets/. Please select the 

study for which you are submitting 

information from the list to upload your 

documents. 

Email submissions: SIPS@epc-src.org. 

Print Submissions 

Mailing Address 

Portland VA Research Foundation, 

Scientific Resource Center, ATTN: 

Scientific Information Packet 

Coordinator, PO Box 69539, Portland, 

OR 97239. 

Shipping Address (FedEx, UPS, etc.) 

Portland VA Research Foundation, 

Scientific Resource Center, ATTN: 

Scientific Information Packet 

Coordinator, 3710 SW U.S. Veterans 

Hospital Road, Mail Code: R&D 71, 

Portland, OR 97239. 

FOR FURTHER INFORMATION CONTACT: 

Ryan McKenna, Telephone: 503–220– 

8262 ext. 58653 or Email: SIPS@epcsrc.org. 

SUPPLEMENTARY INFORMATION: The 

Agency for Healthcare Research and 

Quality has commissioned the 

Evidence-based Practice Centers (EPC) 

Programs to complete a review of the 

evidence for Imaging for Pretreatment 

Staging of Small Cell Lung Cancer. 


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