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Differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey Scores by Recency of the Last Visit

Implications for Comparability of Periodic and Continuous Sampling

Setodji, Claude M. PhD*; Burkhart, Q. MS; Hays, Ron D. PhD; Quigley, Denise D. PhD; Skootsky, Samuel A. MD§; Elliott, Marc N. PhD

doi: 10.1097/MLR.0000000000001134
Online Articles: Applied Methods

Background: Patient experience data can be collected by sampling patients periodically (eg, patients with any visits over a 1-year period) or sampling visits continuously (eg, sampling any visit in a monthly interval). Continuous sampling likely yields a sample with more frequent and more recent visits, possibly affecting the comparability of data collected under the 2 approaches.

Objective: To explore differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey (CG-CAHPS) scores using periodic and continuous sampling.

Research Design: We use observational data to estimate case-mix–adjusted differences in patient experience scores under 12-month periodic sampling and simulated continuous sampling.

Subjects: A total of 29,254 adult patients responding to the CG-CAHPS survey regarding visits in the past 12 months to any of 480 physicians, 2007–2009.

Measures: Overall doctor rating and 4 CG-CAHPS composite measures of patient experience: doctor communication, access to care, care coordination, and office staff.

Results: Compared with 12-month periodic sampling, simulated continuous sampling yielded patients with more recent visits (by definition), more frequent visits (92% of patients with 2+ visits, compared with 76%), and more positive case-mix–adjusted CAHPS scores (2–3 percentage points higher).

Conclusions: Patients with more frequent visits reported markedly higher CG-CAHPS scores, but this causes only small to moderate changes in adjusted physician-level scores between 12-month periodic and continuous sampling schemes. Caution should be exercised in trending or comparing scores collected through different schemes.

*RAND Corporation, Pittsburgh, PA

RAND Corporation, Santa Monica, CA

Division of General Internal Medicine and Health Services Research

§David Geffen School of Medicine, University of California, Los Angeles, CA

Supported by cooperative agreements from the Agency for Healthcare Research and Quality (U18 HS016980 and U18 HS025920).

The authors declare no conflict of interest.

Reprints: Marc N. Elliott, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401. E-mail:

Online date: May 15, 2019

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