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[Federal Register: July 24, 2002 (Volume 67, Number 142)]
[Page 48477-48479]
From the Federal Register Online via GPO Access []
[DOCID: fr24jy02-75]                         



Agency for Healthcare Research and Quality

Request for Measures of Patients' Hospital Care Experiences

AGENCY: Agency for Healthcare Reserach and Quality (AHRQ), HHS.

ACTION: Notice of Request for measures.


SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is 
soliciting the submission of instruments measuring patients' experience 
with the quality of hospital care from researchers, stakeholders and other 
interested parties. This initiative is in response to the priority 
established by the Acting Director of AHRQ and the Administrator of the 
Centers for Medicare & Medicaid Services (CMS), which is to support the 
development of a standard that would be used nation wide. While 
CAHPS®, funded by AHRQ, has been accepted as the industry standard 
for measuring consumers' experiences within the health care system, it 
does not address patients' experiences within the acute care setting. 
In response to this need, AHRQ will initiate the process of developing 
a public domain instrument by reviewing existing instruments that 
capture the patients' hospital experiences.

DATES: Please subject instruments and supporting information by 
September 23, 2002. AHRQ will not respond individually to submitters, 
but will consider all submitted instruments and publicly report the 
results of the review of the submissions in aggregate.

ADDRESSES: Submissions should include a brief cover letter, a copy of 
the instrument for consideration and supporting information as 
specified under Submission Criteria, below. Submissions may be in the 
form of a letter or e-mail, preferably with an electronic file in a 
standard word processing format on a 3-1/2-inch floppy disk or as an 
e-mail attachment. Responses to this request should be submitted to: 
Charles Darby, Agency for Healthcare Research and Quality,  
540 Gaither Road, Suite 3000, Rockville, Maryland 20850, Phone: (301) 427-1324, 
Fax: (301) 427-1341, E-mail:
    To facilitate handling of submissions, please include full 
information about the instrument developer or contact: (a) name, (b) 
title, (c) organization, (d) mailing address, (e) telephone number, (f) 
fax number and (g) e-mail address. Also, please submit a copy of the 
instrument, evidence that it meets the criteria below, i.e., citation 
of a peer-reviewed journal article pertaining to the instrument to 
include the title of the article, author(s), publication year, journal 
name, volume, issue, and page numbers where article appears and or 
other applicable evidence. Submitters must also provide a statement of 
willingness to grant to AHRQ the right to use and authorize others to 
use submitted measures and their documentation as part of a 
CAHPS®-trademarked instrument. This CAHPS® instrument for 
patient assessment of hospital care will be made publicly available, 
free of charge. Please do not use acronyms. Electronic submissions are 

FOR FURTHER INFORMATION CONTACT: Charles Darby, Center for quality 
Improvement and Patient Safety, Agency for Healthcare Research and 
Quality, 540 Gaither Road, Suite 3000, Rockville, Maryland 20850, 
Phone: (301) 427-1324, Fax: (301) 427-1341, E-mail: 

Submission Criteria

    Instruments submitted should focus on acute, inpatient stays for 
medical, surgical care, OB/GYN and/or pediatric care. Measures 
submitted must meet these criteria to be considered: capture the 
patients' experience of care in acute care and/or hospital settings; 
demonstrate a high degree of reliability and validity; and have been 
used widely, not just in one or two research studies or local hospital 
settings. Submitters willingness to grant to AHRQ the right to use and 
authorize others to use the instrument means that the CAHPS® 
trademark will be applied to a new instrument combining the best 
features of all the submissions as well as any ideas that may develop 
from reviewing them, to ensure free access to the instrument, and free 
access to the instrument's supportive/administrative information. AHRQ, 
in collaboration with CAHPS grantees, will evaluate all submitted 
instruments and select one or more either in whole or in part for 
testing and, if required, additional modification. AHRQ will assume 
responsibility for the final measure set as well as any future 
modifications to the instrument.
    The finalized instrument will bear the CAHPS® trademark and it 
will be made freely available for use by all interested parties. 
However, as a matter of quality control, there will be warnings that 
the CAHPS® identification may not be used if any changes are made 
to the instrument or final measure set without review and permission of 
the agency. Each submission should include the following information: 
the name of the instrument, whether the instrument is disease or 
condition specific, domain, language(s) the instrument is available in, 
evidence of cultural/cross group comparability, if any, instrument 
reliability (internal consistency, test-retest, etc.) validity 
(content, construct, criterion-related), response rates, methods and 
results of cognitive testing and field-testing and description of 
sampling strategies and data collection protocols, including such 
elements as mode of administration, use of advance letters, timing and 
frequencies of contacts. In addition, a list of hospitals in which the 
instrument has been fielded or counts of the number of hospitals by 
state or region, in which the survey has been and/or is being used 
should also be included in the submission materials. Submission of 
copies of existing report formats developed to disclose findings to 
consumers and providers is desirable, but not required. Additionally, 
information about existing database(s) for the instrument(s) submitted 
is helpful, but not required for submission. Evidence of the criteria 
should be demonstrated through submission of peer-reviewed journal 
article(s) or through the best evidence available at the time of 



    AHRQ is a leader in developing and testing instruments for 
measuring consumer experience within the healthcare system of the 
United States as evidenced by the development of CAHPS®, formerly 
the Consumer Assessment of Health Plans, which provides information on 
health plan quality to consumers and purchasers alike. While CAPHS® 
is highly regarded within the industry and provides valuable 
information; it does not address patients' experience within an acute 
care setting. Standardization of measures is the basis for the 
development of the CAHPS® system, and is essential for meaningful 
comparison of performance of hospitals and acute care health systems. 
Use of a standardized measure of patient experience in hospital 
settings provides several benefits including: comparable information 
across hospitals for the public about the quality of care from the 
patient's perspective; data-based recommendations for quality 
improvement efforts and a data base to stimulate research in this area.
    Leaders in the health care sector have called for a response to 
these pressing needs. In "Crossing the Quality Chasm," the National 
Institute of Medicine (IOM) established patient-centered care as one of 
the industry's six aims for quality improvement. The dimensions of 
patient-centered care include: respect for patients' values, 
preferences, and expressed needs; coordination and integration of care; 
information, communication, and education; physical comfort; emotional 
support, i.e., relieving fear and anxiety; involvement of family and 
friends; continuity and transition; and access to care (2001).
    The measurement of these dimensions will require a standardized 
instrument that produces reliable and valid results.
    Furthermore, the National Quality Forum (NQF) has cited the need 
for further research and development of suitable performance measures 
to evaluate and improve the quality of care in the hospital setting. 
Among the many priorities cited by the NQF in this area, the need to 
measure patient experiences with inpatient care is crucial.
    In an effect to address the concerns of the industry, the Acting 
Director of AHRQ and the Administrator of the Centers for Medicare & 
Medicaid Services (CMS) have established a priority to develop a 
standard for measuring and the public reporting of patient experiences 
in the acute care setting.
    AHRQ, through a collaborative process with CMS and other Federal 
agencies, as well as other stakeholders, has initiated the process for 
this project. The steps to advance this initiative include:
	o Stakeholder Meetings: A series of public meetings will be 
held to identify the issues, concerns and interests of the healthcare 
community. Summaries of all meetings will be posted on the AHRQ 
Web site: http//
	o Sponsorship: Identify potential sponsors who will fund, 
assist in development and periodic revisions, and ultimately help 
support the process for implementing and maintaining this standardized 
	o Research Plan: The process by which measures will be 
defined and applicable instruments identified. Instruments submitted 
will be evaluated to determine if they meet the measurement needs and 
to identify whether additional measure development is required. Once 
consensus among AHRQ and the CAHPS Grantees on the instrument is 
achieved, and the instrument testing is concluded, the resulting work 
will be readily available free of charge to all prospective users.
	o Implementation Plan: A description of the recommended or 
required process to implement the standardized instrument will also be 
readily available including information related to data collection, 
analysis, and public reporting.

    Dated: July 18, 2002.
Carolyn M. Clancy,
Acting Director.
[FR Doc. 02-18710 Filed 7-23-02; 8:45 am]

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