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Oklahoma Health Care Authority CAHPS® Adult Health Survey for SoonerCare Choice Executive Summary and Technical Specifications Report for Fiscal Year 2010 Report Submitted May 2010 Submitted by: APS Healthcare 4545 North Lincoln Boulevard Suite 24 Oklahoma City, Oklahoma 73105 (405) 556-9700 CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 2 CAHPS® Adult Health Survey for SoonerCare Choice Executive Summary The Oklahoma Health Care Authority (OHCA) is the state agency responsible for administering Medicaid. SoonerCare Choice, the managed care component of Oklahoma Medicaid, operated under a partially capitated case management system during the first half of the state fiscal year (SFY) 2009. A patient-centered medical home model was implemented January 1, 2009. In order to evaluate service satisfaction, the OHCA contracted with APS Healthcare to survey adult members enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009. The OHCA has administered CAHPS (Consumer Assessment of Healthcare Providers Systems) surveys to measure consumer satisfaction in the Medicaid population since 1996. Comparing the 2008 survey and the 2010 survey, results indicated fairly high levels of satisfaction holding steady across an array of eight quality measures. The overall picture drawn by the CAHPS data is one of high and rising satisfaction with several different aspects of health care received from SoonerCare providers, and also customer services provided directly by SoonerCare. Positive trends were seen in ratings of health care, personal physicians, specialists, and the health plan, and also in composite measures of getting care quickly, provider communication, getting needed care, and customer service. One increase was statistically significant; respondents gave higher ratings on how often they were able to get care quickly. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 3 CAHPS® Adult Health Survey for SoonerCare Choice Technical Specifications Consumer satisfaction surveys are an important source of information to consumers, purchasers of health care, health plans and program administrators. By responding to satisfaction surveys, individuals provide valuable information regarding access to care, use of services, and satisfaction with the care they have received. To survey the general population of managed care members about their overall experience with their health plan, the Oklahoma Health Care Authority (OHCA) has administered Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to SoonerCare members since 1996. CAHPS questionnaires, administration protocol and survey analysis were developed by Harvard, RAND and the Research Triangle Institute. The health care community has accepted these methods in producing consumer satisfaction measures that may be compared across health plans and health service delivery types. In order to evaluate service satisfaction, the OHCA contracted with APS Healthcare (APS) to survey the members enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009. This technical report includes information on the survey methodology, findings, and summary information on the respondents’ satisfaction with health plan services they received. Method The Adult CAHPS Health Plan Survey 4.0 questionnaire (shown in Appendix A) was administered by The Myers Group (TMG) between December 16, 2009, and April 1, 2010. The questionnaire addressed several aspects of health plan performance, including: • Rating of personal doctors, specialists, health care received, and health plan • Receiving care without long waits • Communication with clinicians • Health plan information and customer service CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 4 • Getting needed care Sampling Because it is not feasible to survey the entire SoonerCare Choice population, TMG used recognized sampling techniques to obtain information from a limited number of members. This information is used to estimate the consumer satisfaction of the SoonerCare Choice population as a whole. Sampling for this survey followed CAHPS 4.0 protocols with one exception: APS limited the sample to members with at least one paid claim from a SoonerCare Choice provider. APS provided TMG with a list of eligible members for sample selection. Each member included in the eligibility list met the following criteria: • 18 years of age or older as of November 30, 2009; • Enrolled in the SoonerCare Choice program as of November 30, 2009; and • Continuously enrolled in SoonerCare Choice for 12 months between December 1, 2008, and November 30, 2009. (Continuous enrollment was defined as having no more than one 45-day break in enrollment during the year.) In accordance with CAHPS recommendations and to reduce the burden on respondents, TMG randomly selected only one member from a household for the sample. The CAHPS Survey and Reporting Kit 4.0 standards indicate that a minimum of 300 completed surveys are needed for a valid administration. The total number of members eligible for the survey was 44,772; TMG selected a random sample of 1,688 members. Data Collection The CAHPS survey methodology allowed data to be collected by mail, telephone interview, or a combination of mail and telephone. The OHCA and APS agreed to conduct these surveys using mail and incorporated telephone interviewing only when the targeted response rate was not received. The survey process had outreach interventions that included mailings of the survey packet, reminder postcards and phone follow-up with interviewers. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 5 After the sample was selected, address lists were processed using the U.S. Postal Service’s CASS Certified ZIP + 4 Coding Software, which verified the zip code for each address. Each packet included a questionnaire and a letter that explained the purpose and the importance of the survey. To encourage participation, the packet also contained a postage-paid business reply envelope. Reminder postcards served to thank individuals who had responded to the survey and to remind others to complete their questionnaires. Members selected for the sample who did not respond to the first survey and/or postcard mailings were mailed a second survey. All correspondence included a toll-free number that members could use to contact TMG with questions regarding the survey or to complete the survey over the telephone. Each information letter contained a statement written in Spanish asking the member to call the toll-free number to take the survey by phone with a Spanish interpreter. If needed, follow-up calls were then initiated with bilingual interviewers. TMG developed a database to track the status of members selected for the sample at each stage of the survey protocol. The database identified members who had not returned the survey and needed additional mailings. The database also indicated the date that a member responded to the survey, refused to participate in the survey or was determined to be ineligible for the survey. Members were determined to be ineligible for the survey if they no longer qualified for SoonerCare or had moved to another state. Data Coding and Data Entry TMG recorded the responses to the questionnaires in a database specifically designed for this purpose. The data entry program permitted the entry of only those responses that were within the accepted range for each specific item; for example, if a rating was supposed to be on a scale of 0 to 10, a response of 12 could not be entered. TMG performed a data clean-up process prior to the actual analysis to detect any additional out-of-range values and response inconsistencies. Typically, inconsistencies occurred when respondents did not follow the skip pattern of question groups. When feasible, TMG recoded the items to conform to the questionnaire skip patterns; for example, if one response indicated the person did not receive forms to fill out, then it CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 6 would not make sense for the person to answer the next question about the ease of completing the forms. However, when the intent of the respondent could not be determined, the analyst recoded the item as missing. Data Analysis All analyses and calculations in the study were performed by APS using SAS 9.2, including the standard CAHPS analysis macro “cc250_cahps36b.sas.” Frequencies were computed for all the items on the survey. Due to the lengthy results for this type of analysis, the frequency distributions are reported in Appendix B rather than in the results section. The statistical analysis consisted of comparing this year’s survey results with those from the previous administration of the survey, which was in state fiscal year (SFY) 2008, using the t-test statistic for difference of means as incorporated in the standard CAHPS analysis macro. Global ratings, which used a scale of 0 to 10, measured the respondents’ assessment of their health plan and the quality of the care received. APS computed the means for each global rating and used a t-test to compare means from the SFY 2008 and SFY 2010 SoonerCare Choice surveys. Four global ratings were compared between SFY 2010 and SFY 2008: • Overall Rating of Health Care • Overall Rating of Personal Doctor • Overall Rating of Specialist • Overall Rating of Health Plan Composite measures combine the responses to questions that are closely related to each other and provide more reliable results than comparing each item separately. APS computed the mean scores for each composite and used t-tests to compare means from the SFY 2008 and SFY 2010 SoonerCare Choice surveys. The four composites that could be compared were: • Experiences in Getting Treatment Quickly CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 7 • Experiences with How Well Clinicians Communicate • Experience with Getting Needed Care • Experience with Information and Customer Service Results Table 1 shows the response rate by method for the current year’s survey and the previous administration of the survey from SFY 2008. Table 1. Completed Surveys Rate by Method each Survey by Year Completed Surveys SFY 2010 Survey SFY 2008 Survey Mailing 520 238 Phone Follow-Up 108 95 Total Completed Surveys 628 333 The study evaluated each returned questionnaire to determine whether it met the CAHPS definition for a completed survey. To be considered complete, a questionnaire must have had at least one answered question. APS coded returned questionnaires that did not pass the completion criteria as non-respondents and excluded them from the analysis. Additionally, returned surveys received by TMG included refusals returned by mail and those from SoonerCare Choice members who had moved out of state or were not in the plan. The adjusted response rate, expressed as a percentage, is the number of completed surveys divided by the number of eligible surveys. Number of completed surveys Number of eligible surveys x 100 = Adjusted response rate (total completes) 628 (Sample) –(Ineligible) = 1688 – 106 x 100 = 39.7% The adjusted response rates for the current (SFY 2010) SoonerCare Choice survey was 39.7%; the adjusted response rates for the previous (SFY 2008) SoonerCare Choice survey was 21.0%. The difference in response rates may be attributable to the decision in CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 8 SFY 2010 to limit the sampling frame to participants who had a paid claim during the sample timeframe. Table 2 displays the disposition of surveys deemed ineligible by number and percentage for SFY 2010. Table 2. Number and Percentage of Ineligible Surveys for SFY 2010 Ineligible Disposition N % Deceased 3 0.18 Mentally/Physically Incapacitated 14 0.83 Does Not Meet Criteria 89 5.27 Total Ineligibles 106 6.28 The most frequent reason for exclusion was that the survey did not contain at least one answered question. Demographics Respondents were asked their race and ethnicity. Figure 1 shows these results. Figure 1. Respondent’s Reported Racial Identity African American 13.5% Caucasian 65.6% Native American 8.0% Multiracial / Other 13.0% Caucasians represented the majority of respondents with 65.6%. Members who were African American or multiracial/other were nearly equally represented at 13.5% and CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 9 13%, respectively. In response to a separate question about ethnicity, 5.5% of the respondents reported to be Hispanic or Latino. Global Ratings In Figures 2 through 5, the overall ratings are shown for the following: • The adult’s health care received • The adult’s personal doctor • The adult’s specialist • The adult’s health plan The means for the global rating items for the two years are shown in bar graphs. The table below each graph lists the number of respondents analyzed, the means and the p-value associated with the t-test of mean difference between the two years. A p-value less than .05 was considered statistically significant. That is, if the p-value was less than .05 the two means were statistically different from each other; otherwise, the two means were not statistically different.* * A statistical note: The standard CAHPS analysis does not assume equal variances, but it did not compute a difference between the OHCA results for SFY 2008 and SFY 2010. APS used SAS PROC TTEST to compute the significance of difference between years. Reported p-values are from pooled tests with equal variances assumed. Only one question failed a test of equal variances, but the decision on the hypothesis test of equal means would have been the same with a t-test that did not assume equal variances. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 10 Overall Rating of Health Care Received • Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months? Figure 2. Rating of Health Care Received 7.58 7.66 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 495 7.66 2008 251 7.58 .6631 Figure 2 demonstrates that SoonerCare Choice members remained fairly satisfied with the health care they received in 2010 compared with the ratings in 2008. The slight increase was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 11 Overall Rating for Personal Doctor • Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor in the last 6 months? Figure 3. Overall Rating for Personal Doctor 7.74 8.08 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 496 8.08 2008 249 7.74 .0833 Figure 3 shows that SoonerCare Choice members were highly satisfied with their personal doctor in 2010. The slight increase in satisfaction from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 12 Overall Rating for Specialist • We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist? Figure 4. Overall Rating for Specialist 8.00 8.39 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 247 8.39 2008 112 8.00 .1468 Figure 4 shows that SoonerCare Choice members were highly satisfied with their specialist doctor seen most often in 2010. The slight increase from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 13 Overall Rating for Health Plan • Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan? Figure 5. Overall Rating for Health Plan 7.59 7.82 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 569 7.82 2008 306 7.59 .1718 Figure 5 shows that SoonerCare Choice members were generally satisfied with their health plan in 2010. The increase from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 14 Composite Measures In Figures 6 through 9, composite measures for the following services are provided: • Experiences in getting treatment quickly • Experiences with how well clinicians communicate • Experiences with getting needed treatment • Experiences with health plan information and customer service These questions were answered on a four-point ordinal scale, where 1= “never,” 2 = “sometimes,” 3 = “usually,” and 4 = “always.” Responses of “never” and “sometimes” were combined into one category for the purpose of graphing since there were small percentages in those categories. The mean of the four-point scale was computed and compared between years using a t-test, following standard CAHPS analysis protocol. The percentage in each category for the composite measures is shown in the bar graph. The table below each graph lists the number of respondents analyzed, the mean and the p-value associated with the t-test comparison of means. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 15 Getting Treatment Quickly • In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed? • In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for health care at a doctor’s office or clinic as soon as you thought you needed? Figure 6. Getting Treatment Quickly 22.88% 18.24% 25.12% 22.18% 52.01% 59.58% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 523 3.38 2008 281 3.24 .0099 Figure 6 shows that 59.58% of the respondents in 2010 reported they always received treatment quickly. The difference of means from 2008 was statistically significant, as 52.01% of respondents in 2008 reported that they always received treatment quickly. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 16 How Well Clinicians Communicate • In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand? • In the last 6 months, how often did your personal doctor listen carefully to you? • In the last 6 months, how often did your personal doctor show respect for what you had to say? • In the last 6 months, how often did your personal doctor spend enough time with you? Figure 7. How Well Clinicians Communicate 19.61% 15.78% 22.06% 21.15% 58.33% 63.06% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 440 3.43 2008 226 3.34 .1233 Figure 7 indicates that 63.06% of members felt that their clinicians always communicated well during SFY 2010. This was an increase from 58.33% in SFY 2007; however, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 17 Getting Needed Health Care • In the last 6 months, how often was it easy to get appointments with specialists? • In the last 6 months, how often was it easy to get the care, tests, or treatment you thought you needed through your health plan? Figure 8. How Often Needed Health Care was Easy to Get 27.24% 22.18% 27.25% 27.71% 45.51% 50.11% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 409 3.21 2008 216 3.07 .5551 Figure 8 indicates that 50.11% of members felt that they always had easy access to specialists and needed treatment during SFY 2010. This was an increase from 45.51% in SFY 2008; however, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 18 Health Plan Information and Customer Service • In the last 6 months, how often did your health plan's customer service give you the information or help you needed? • In the last 6 months, how often did your health plan's customer service staff treat you with courtesy and respect? Figure 9. How Often Customer Service Gave Information, Courtesy, and Respect 12.06% 12.62% 22.36% 16.95% 65.58% 70.42% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 128 3.26 2008 90 3.25 .8897 Figure 9 indicates that 70.42% of members felt that their clinicians always communicated well during SFY 2010. Although this was an increase from 65.58% in SFY 2008, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 19 Discussion The overall picture drawn by the CAHPS data is one of high and rising satisfaction with several different aspects of health care received from SoonerCare providers, and also customer services provided directly by SoonerCare. Positive trends were seen in ratings of health care, personal physicians, specialists, the health plan, and also in composite measures of getting care quickly, provider communication, getting needed care, and customer service. One measure increased enough to be statistically significant: respondents reported an increase in how often they were able to get care quickly. The SFY 2010 sampling methodology involved limiting the sampling frame to members who had a paid health claim. Using this method, the number of completed surveys increased by 89% when compared to SFY 2008. The increase in completed surveys also contributed to an adjusted response rate that was 89% higher than the previous year. It appears to be a successful method in that members utilizing SoonerCare services were more likely to have an opinion regarding their health care. APS recommends the OHCA continue to follow this sampling methodology for future surveys. Appendix A APPENDIX A CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 22 Appendix B Below are the responses for each survey question. There were 628 total completed questionnaires. Frequencies depicted in the tables reflect the number of people responding to each item; percentages depicted in the tables reflect the total number of respondents to the particular question. Non-responses or missing data are omitted from each table. 1. Our records show that you are now in SoonerCare Choice. Is that right? Q1 Frequency Percent Yes 625 100.00 3. In the last 6 months, did you have an illness, injury, or condition that needed care right away in a clinic, emergency room or doctor's office? Q3 Frequency Percent Yes 364 60.97 No 233 39.03 Total 597 100.00 4. In the last 6 months, when you needed care right away how often did you get care as soon as you thought you needed? Q4 Frequency Percent Never 13 3.61 Sometimes 48 13.33 Usually 81 22.50 Always 218 60.56 Total 360 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 23 5. In the last 6 months, not counting the times you needed care right away, did you make any appointments for your health care at a doctor's office or clinic? Q5 Frequency Percent Yes 479 80.64 No 115 19.36 Total 594 100.00 6. In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor's office or clinic as soon as you thought you needed? Q6 Frequency Percent Never 14 2.97 Sometimes 78 16.56 Usually 103 21.87 Always 276 58.60 Total 471 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 24 7. In the last 6 months, not counting times you went to an emergency room, how many times did you go to a doctor's office or clinic to get care for yourself? Q7 Frequency Percent 0 70 12.13 1 83 14.38 2 97 16.81 3 85 14.73 4 72 12.48 5 to 9 120 20.80 10 or more 50 8.67 Total 577 100.00 8. In the last 6 months, how often did you and a doctor or other health provider talk about specific things you could do to prevent illness? Q8 Frequency Percent Never 70 14.00 Sometimes 122 24.40 Usually 126 25.20 Always 182 36.40 Total 500 100.00 9. In the last 6 months, did a doctor or other health provider tell you there was more than one choice for your treatment or health care? Q9 Frequency Percent Yes 242 48.69 No 255 51.31 Total 497 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 25 10. In the last 6 months, did a doctor or other health provider talk with you about the pros and cons of each choice for your treatment or health care? Q10 Frequency Percent Definitely Yes 132 55.00 Somewhat Yes 84 35.00 Somewhat No 18 7.50 Definitely No 6 2.50 Total 240 100.00 11. In the last 6 months, when there was more than one choice for your treatment or health care, did a doctor or other health provider ask which choice you thought was best for you? Q11 Frequency Percent Definitely Yes 119 50.00 Somewhat Yes 94 39.50 Somewhat No 12 5.04 Definitely No 13 5.46 Total 238 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 26 12. Rating of all health care Q12 Frequency Percent 0 Worst 8 1.62 1 6 1.21 2 4 0.81 3 13 2.63 4 21 4.24 5 52 10.51 6 32 6.46 7 54 10.91 8 79 15.96 9 67 13.54 10 Best 159 32.12 Total 495 100.00 13. Do you have a personal doctor? Q13 Frequency Percent Yes 511 87.50 No 73 12.50 Total 584 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 27 14. In the last 6 months, how many times did you visit your personal doctor to get care for yourself? Q14 Frequency Percent 0 62 12.33 1 89 17.69 2 89 17.69 3 72 14.31 4 70 13.92 5 to 9 96 19.09 10 or more 25 4.97 Total 503 100.00 15. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand? Q15 Frequency Percent Never 17 3.88 Sometimes 44 10.05 Usually 99 22.60 Always 278 63.47 Total 438 100.00 16. In the last 6 months, how often did your personal doctor listen carefully to you? Q16 Frequency Percent Never 19 4.35 Sometimes 56 12.81 Usually 85 19.45 Always 277 63.39 Total 437 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 28 17. In the last 6 months, how often did your personal doctor show respect for what you had to say? Q17 Frequency Percent Never 15 3.43 Sometimes 43 9.84 Usually 82 18.76 Always 297 67.96 Total 437 100.00 18. In the last 6 months, how often did your personal doctor spend enough time with you? Q18 Frequency Percent Never 22 5.03 Sometimes 60 13.73 Usually 104 23.80 Always 251 57.44 Total 437 100.00 19. In the last 6 months, did you get care from a doctor or other health provider besides your personal doctor? Q19 Frequency Percent Yes 288 65.90 No 149 34.10 Total 437 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 29 20. In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from these doctors or other health providers? Q20 Frequency Percent Never 34 12.06 Sometimes 48 17.02 Usually 73 25.89 Always 127 45.04 Total 282 100.00 21. Rating of personal doctor Q21 Frequency Percent 0 Worst 9 1.81 1 6 1.21 2 10 2.02 3 9 1.81 4 15 3.02 5 30 6.05 6 24 4.84 7 37 7.46 8 75 15.12 9 69 13.91 10 Best 212 42.74 Total 496 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 30 22. In the last 6 months, did you try to make any appointments to see a specialist? Q22 Frequency Percent Yes 275 47.66 No 302 52.34 Total 577 100.00 23. In the last 6 months, how often was it easy to get appointments with specialists? Q23 Frequency Percent Never 22 8.09 Sometimes 41 15.07 Usually 72 26.47 Always 137 50.37 Total 272 100.00 24. How many specialists have you seen in the last 6 months? Q24 Frequency Percent 0 24 8.79 1 142 52.01 2 57 20.88 3 27 9.89 4 14 5.13 5 9 3.30 Total 273 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 31 25. Rating of specialist saw most often Q25 Frequency Percent 0 Worst 2 0.81 1 1 0.40 2 5 2.02 3 5 2.02 4 8 3.24 5 9 3.64 6 18 7.29 7 14 5.67 8 24 9.72 9 38 15.38 10 Best 123 49.80 Total 247 100.00 26. In the last 6 months, did you try to get any kind of care, tests, or treatment through your health plan? Q26 Frequency Percent Yes 351 61.58 No 219 38.42 Total 570 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 32 27. In the last 6 months, how often was it easy to get care, tests, or treatment you thought you needed through your health plan? Q27 Frequency Percent Never 20 5.73 Sometimes 54 15.47 Usually 101 28.94 Always 174 49.86 Total 349 100.00 28. In the last 6 months, did you look for any information in written materials or on the Internet about how your health plan works? Q28 Frequency Percent Yes 91 15.77 No 486 84.23 Total 577 100.00 29. In the last 6 months, how often did the written materials or the Internet provide the information you needed about how your health plan works? Q29 Frequency Percent Never 4 4.49 Sometimes 22 24.72 Usually 33 37.08 Always 30 33.71 Total 89 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 33 30. In the last 6 months, did you try to get information or help from your health plan's customer service? Q30 Frequency Percent Yes 129 22.47 No 445 77.53 Total 574 100.00 31. In the last 6 months, how often did your health plan's customer service give you the information or help you needed? Q31 Frequency Percent Never 11 8.66 Sometimes 23 18.11 Usually 32 25.20 Always 61 48.03 Total 127 100.00 32. In the last 6 months, how often did your health plan's customer service staff treat you with courtesy and respect? Q32 Frequency Percent Never 9 7.20 Sometimes 12 9.60 Usually 27 21.60 Always 77 61.60 Total 125 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 34 33. In the last 6 months, did your health plan give you any forms to fill out? Q33 Frequency Percent Yes 125 22.08 No 441 77.92 Total 566 100.00 34. In the last 6 months, how often were the forms from your health plan easy to fill out? Q34 Frequency Percent Never 7 5.83 Sometimes 23 19.17 Usually 46 38.33 Always 44 36.67 Total 120 100.00 35. Rating of your health plan Q35 Frequency Percent 0 Worst 10 1.76 1 5 0.88 2 9 1.58 3 5 0.88 4 20 3.51 5 47 8.26 6 42 7.38 7 65 11.42 8 101 17.75 9 68 11.95 10 Best 197 34.62 Total 569 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 35 36. In general, how would you rate your overall health? Q36 Frequency Percent Excellent 38 6.55 Very Good 88 15.17 Good 172 29.66 Fair 180 31.03 Poor 102 17.59 Total 580 100.00 37. Do you now smoke cigarettes or use tobacco every day, some days, or not at all? Q37 Frequency Percent Every day 191 32.76 Some days 74 12.69 Not at all 305 52.32 Don’t know 13 2.23 Total 583 100.00 38. In the last 6 months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider in your plan? Q38 Frequency Percent Never 58 22.14 Sometimes 65 24.81 Usually 48 18.32 Always 91 34.73 Total 262 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 36 39. In the last 6 months, how often was medication recommended or discussed by a doctor or health provider to assist you with quitting smoking or using tobacco? Q39 Frequency Percent Never 127 49.22 Sometimes 64 24.81 Usually 29 11.24 Always 38 14.73 Total 258 100.00 40. In the last 6 months, how often did your doctor or health provider discuss or provide methods and strategies other than medication to assist you with quitting smoking or using tobacco? Q40 Frequency Percent Never 156 61.18 Sometimes 49 19.22 Usually 21 8.24 Always 29 11.37 Total 255 100.00 41. Do you take aspirin daily or every other day? Q41 Frequency Percent Yes 162 28.52 No 406 71.48 Total 568 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 37 42. Do you have a health problem or take medication that makes taking aspirin unsafe for you? Q42 Frequency Percent Yes 81 16.30 No 416 83.70 Total 497 100.00 43. Has a doctor or health provider ever discussed with you the risks and benefits of aspirin to prevent heart attack or stroke? Q43 Frequency Percent Yes 237 41.22 No 338 58.78 Total 575 100.00 44. Are you aware that you have any of the following conditions? High cholesterol Q44A Frequency Percent No 441 70.22 Yes 187 29.78 Total 628 100.00 44. Are you aware that you have any of the following conditions? High blood pressure Q44B Frequency Percent No 374 59.55 Yes 254 40.45 Total 628 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 38 44. Are you aware that you have any of the following conditions? Parent or sibling with heart attack before the age of 60 Q44C Frequency Percent No 479 76.27 Yes 149 23.73 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? A heart attack Q45A Frequency Percent No 577 91.88 Yes 51 8.12 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? Angina or coronary heart disease Q45B Frequency Percent No 577 91.88 Yes 51 8.12 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? A stroke Q45C Frequency Percent No 578 92.04 Yes 50 7.96 Total 628 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 39 45. Has a doctor ever told you that you have any of the following conditions? Any kind of diabetes or high blood sugar Q45D Frequency Percent No 481 76.59 Yes 147 23.41 Total 628 100.00 46. In the last 6 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem? Q46 Frequency Percent Yes 322 55.23 No 261 44.77 Total 583 100.00 47. Is this a condition or problem that has lasted for at least 3 months? Do not include pregnancy or menopause. Q47 Frequency Percent Yes 270 86.26 No 43 13.74 Total 313 100.00 48. Do you now need or take medicine prescribed by a doctor? Do not include birth control. Q48 Frequency Percent Yes 477 81.82 No 106 18.18 Total 583 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 40 49. Is this to treat a condition that has lasted for at least 3 months? Do not include pregnancy or menopause. Q49 Frequency Percent Yes 428 92.04 No 37 7.96 Total 465 100.00 50. What is your age? Q50 Frequency Percent 18-24 107 18.26 25-34 73 12.46 35-44 99 16.89 45-54 169 28.84 55-64 135 23.04 65-74 3 0.51 Total 586 100.00 51. Are you male or female? Q51 Frequency Percent Male 187 32.13 Female 395 67.87 Total 582 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 41 52. What is the highest grade or level of school that you have completed? Q52 Frequency Percent 8th grade or less 44 7.61 Some high school 156 26.99 HS grad or GED 229 39.62 Some college 131 22.66 College grad 15 2.60 More than 4yr college 3 0.52 Total 578 100.00 53. Are you of Hispanic or Latino origin or descent? Q53 Frequency Percent Yes 30 5.49 No 516 94.51 Total 546 100.00 54. What is your race? Q54 Frequency Percent White 379 65.57 Black or African American 78 13.49 American Indian or Alaska Native1 46 7.96 Multiracial / Other2 75 12.98 Total 578 100.00 1The race categories are based upon the standard CMS nomenclature for all Medicaid programs. 2Respondents who selected more than one race were grouped in the multiracial / other category. CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 42 55. Did someone help you complete this survey? Q55 Frequency Percent Yes 114 24.20 No 357 75.80 Total 471 100.00 56. How did that person help you? Read the questions to me Q56A Frequency Percent No 47 41.23 Yes 67 58.77 Total 114 100.00 56. How did that person help you? Wrote down the answers I gave Q56B Frequency Percent No 69 60.53 Yes 45 39.47 Total 114 100.00 56. How did that person help you? Answered the questions for me Q56C Frequency Percent No 81 71.05 Yes 33 28.95 Total 114 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 43 56. How did that person help you? Translated the questions into my language Q56D Frequency Percent No 108 94.74 Yes 6 5.26 Total 114 100.00 56. How did that person help you? Helped in some other way Q56E Frequency Percent No 103 90.35 Yes 11 9.65 Total 114 100.00
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Title | CAHPS adult health survey |
OkDocs Class# | H1300.8 C132m 2010 |
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ODL electronic copy | Downloaded from agency website: http://www.okhca.org/pdf/Adult_CAHPS%20Member_Survey_SFY2010.pdf |
Rights and Permissions | This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders. |
Language | English |
Full text | Oklahoma Health Care Authority CAHPS® Adult Health Survey for SoonerCare Choice Executive Summary and Technical Specifications Report for Fiscal Year 2010 Report Submitted May 2010 Submitted by: APS Healthcare 4545 North Lincoln Boulevard Suite 24 Oklahoma City, Oklahoma 73105 (405) 556-9700 CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 2 CAHPS® Adult Health Survey for SoonerCare Choice Executive Summary The Oklahoma Health Care Authority (OHCA) is the state agency responsible for administering Medicaid. SoonerCare Choice, the managed care component of Oklahoma Medicaid, operated under a partially capitated case management system during the first half of the state fiscal year (SFY) 2009. A patient-centered medical home model was implemented January 1, 2009. In order to evaluate service satisfaction, the OHCA contracted with APS Healthcare to survey adult members enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009. The OHCA has administered CAHPS (Consumer Assessment of Healthcare Providers Systems) surveys to measure consumer satisfaction in the Medicaid population since 1996. Comparing the 2008 survey and the 2010 survey, results indicated fairly high levels of satisfaction holding steady across an array of eight quality measures. The overall picture drawn by the CAHPS data is one of high and rising satisfaction with several different aspects of health care received from SoonerCare providers, and also customer services provided directly by SoonerCare. Positive trends were seen in ratings of health care, personal physicians, specialists, and the health plan, and also in composite measures of getting care quickly, provider communication, getting needed care, and customer service. One increase was statistically significant; respondents gave higher ratings on how often they were able to get care quickly. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 3 CAHPS® Adult Health Survey for SoonerCare Choice Technical Specifications Consumer satisfaction surveys are an important source of information to consumers, purchasers of health care, health plans and program administrators. By responding to satisfaction surveys, individuals provide valuable information regarding access to care, use of services, and satisfaction with the care they have received. To survey the general population of managed care members about their overall experience with their health plan, the Oklahoma Health Care Authority (OHCA) has administered Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to SoonerCare members since 1996. CAHPS questionnaires, administration protocol and survey analysis were developed by Harvard, RAND and the Research Triangle Institute. The health care community has accepted these methods in producing consumer satisfaction measures that may be compared across health plans and health service delivery types. In order to evaluate service satisfaction, the OHCA contracted with APS Healthcare (APS) to survey the members enrolled in SoonerCare Choice between December 1, 2008, and November 30, 2009. This technical report includes information on the survey methodology, findings, and summary information on the respondents’ satisfaction with health plan services they received. Method The Adult CAHPS Health Plan Survey 4.0 questionnaire (shown in Appendix A) was administered by The Myers Group (TMG) between December 16, 2009, and April 1, 2010. The questionnaire addressed several aspects of health plan performance, including: • Rating of personal doctors, specialists, health care received, and health plan • Receiving care without long waits • Communication with clinicians • Health plan information and customer service CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 4 • Getting needed care Sampling Because it is not feasible to survey the entire SoonerCare Choice population, TMG used recognized sampling techniques to obtain information from a limited number of members. This information is used to estimate the consumer satisfaction of the SoonerCare Choice population as a whole. Sampling for this survey followed CAHPS 4.0 protocols with one exception: APS limited the sample to members with at least one paid claim from a SoonerCare Choice provider. APS provided TMG with a list of eligible members for sample selection. Each member included in the eligibility list met the following criteria: • 18 years of age or older as of November 30, 2009; • Enrolled in the SoonerCare Choice program as of November 30, 2009; and • Continuously enrolled in SoonerCare Choice for 12 months between December 1, 2008, and November 30, 2009. (Continuous enrollment was defined as having no more than one 45-day break in enrollment during the year.) In accordance with CAHPS recommendations and to reduce the burden on respondents, TMG randomly selected only one member from a household for the sample. The CAHPS Survey and Reporting Kit 4.0 standards indicate that a minimum of 300 completed surveys are needed for a valid administration. The total number of members eligible for the survey was 44,772; TMG selected a random sample of 1,688 members. Data Collection The CAHPS survey methodology allowed data to be collected by mail, telephone interview, or a combination of mail and telephone. The OHCA and APS agreed to conduct these surveys using mail and incorporated telephone interviewing only when the targeted response rate was not received. The survey process had outreach interventions that included mailings of the survey packet, reminder postcards and phone follow-up with interviewers. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 5 After the sample was selected, address lists were processed using the U.S. Postal Service’s CASS Certified ZIP + 4 Coding Software, which verified the zip code for each address. Each packet included a questionnaire and a letter that explained the purpose and the importance of the survey. To encourage participation, the packet also contained a postage-paid business reply envelope. Reminder postcards served to thank individuals who had responded to the survey and to remind others to complete their questionnaires. Members selected for the sample who did not respond to the first survey and/or postcard mailings were mailed a second survey. All correspondence included a toll-free number that members could use to contact TMG with questions regarding the survey or to complete the survey over the telephone. Each information letter contained a statement written in Spanish asking the member to call the toll-free number to take the survey by phone with a Spanish interpreter. If needed, follow-up calls were then initiated with bilingual interviewers. TMG developed a database to track the status of members selected for the sample at each stage of the survey protocol. The database identified members who had not returned the survey and needed additional mailings. The database also indicated the date that a member responded to the survey, refused to participate in the survey or was determined to be ineligible for the survey. Members were determined to be ineligible for the survey if they no longer qualified for SoonerCare or had moved to another state. Data Coding and Data Entry TMG recorded the responses to the questionnaires in a database specifically designed for this purpose. The data entry program permitted the entry of only those responses that were within the accepted range for each specific item; for example, if a rating was supposed to be on a scale of 0 to 10, a response of 12 could not be entered. TMG performed a data clean-up process prior to the actual analysis to detect any additional out-of-range values and response inconsistencies. Typically, inconsistencies occurred when respondents did not follow the skip pattern of question groups. When feasible, TMG recoded the items to conform to the questionnaire skip patterns; for example, if one response indicated the person did not receive forms to fill out, then it CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 6 would not make sense for the person to answer the next question about the ease of completing the forms. However, when the intent of the respondent could not be determined, the analyst recoded the item as missing. Data Analysis All analyses and calculations in the study were performed by APS using SAS 9.2, including the standard CAHPS analysis macro “cc250_cahps36b.sas.” Frequencies were computed for all the items on the survey. Due to the lengthy results for this type of analysis, the frequency distributions are reported in Appendix B rather than in the results section. The statistical analysis consisted of comparing this year’s survey results with those from the previous administration of the survey, which was in state fiscal year (SFY) 2008, using the t-test statistic for difference of means as incorporated in the standard CAHPS analysis macro. Global ratings, which used a scale of 0 to 10, measured the respondents’ assessment of their health plan and the quality of the care received. APS computed the means for each global rating and used a t-test to compare means from the SFY 2008 and SFY 2010 SoonerCare Choice surveys. Four global ratings were compared between SFY 2010 and SFY 2008: • Overall Rating of Health Care • Overall Rating of Personal Doctor • Overall Rating of Specialist • Overall Rating of Health Plan Composite measures combine the responses to questions that are closely related to each other and provide more reliable results than comparing each item separately. APS computed the mean scores for each composite and used t-tests to compare means from the SFY 2008 and SFY 2010 SoonerCare Choice surveys. The four composites that could be compared were: • Experiences in Getting Treatment Quickly CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 7 • Experiences with How Well Clinicians Communicate • Experience with Getting Needed Care • Experience with Information and Customer Service Results Table 1 shows the response rate by method for the current year’s survey and the previous administration of the survey from SFY 2008. Table 1. Completed Surveys Rate by Method each Survey by Year Completed Surveys SFY 2010 Survey SFY 2008 Survey Mailing 520 238 Phone Follow-Up 108 95 Total Completed Surveys 628 333 The study evaluated each returned questionnaire to determine whether it met the CAHPS definition for a completed survey. To be considered complete, a questionnaire must have had at least one answered question. APS coded returned questionnaires that did not pass the completion criteria as non-respondents and excluded them from the analysis. Additionally, returned surveys received by TMG included refusals returned by mail and those from SoonerCare Choice members who had moved out of state or were not in the plan. The adjusted response rate, expressed as a percentage, is the number of completed surveys divided by the number of eligible surveys. Number of completed surveys Number of eligible surveys x 100 = Adjusted response rate (total completes) 628 (Sample) –(Ineligible) = 1688 – 106 x 100 = 39.7% The adjusted response rates for the current (SFY 2010) SoonerCare Choice survey was 39.7%; the adjusted response rates for the previous (SFY 2008) SoonerCare Choice survey was 21.0%. The difference in response rates may be attributable to the decision in CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 8 SFY 2010 to limit the sampling frame to participants who had a paid claim during the sample timeframe. Table 2 displays the disposition of surveys deemed ineligible by number and percentage for SFY 2010. Table 2. Number and Percentage of Ineligible Surveys for SFY 2010 Ineligible Disposition N % Deceased 3 0.18 Mentally/Physically Incapacitated 14 0.83 Does Not Meet Criteria 89 5.27 Total Ineligibles 106 6.28 The most frequent reason for exclusion was that the survey did not contain at least one answered question. Demographics Respondents were asked their race and ethnicity. Figure 1 shows these results. Figure 1. Respondent’s Reported Racial Identity African American 13.5% Caucasian 65.6% Native American 8.0% Multiracial / Other 13.0% Caucasians represented the majority of respondents with 65.6%. Members who were African American or multiracial/other were nearly equally represented at 13.5% and CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 9 13%, respectively. In response to a separate question about ethnicity, 5.5% of the respondents reported to be Hispanic or Latino. Global Ratings In Figures 2 through 5, the overall ratings are shown for the following: • The adult’s health care received • The adult’s personal doctor • The adult’s specialist • The adult’s health plan The means for the global rating items for the two years are shown in bar graphs. The table below each graph lists the number of respondents analyzed, the means and the p-value associated with the t-test of mean difference between the two years. A p-value less than .05 was considered statistically significant. That is, if the p-value was less than .05 the two means were statistically different from each other; otherwise, the two means were not statistically different.* * A statistical note: The standard CAHPS analysis does not assume equal variances, but it did not compute a difference between the OHCA results for SFY 2008 and SFY 2010. APS used SAS PROC TTEST to compute the significance of difference between years. Reported p-values are from pooled tests with equal variances assumed. Only one question failed a test of equal variances, but the decision on the hypothesis test of equal means would have been the same with a t-test that did not assume equal variances. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 10 Overall Rating of Health Care Received • Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months? Figure 2. Rating of Health Care Received 7.58 7.66 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 495 7.66 2008 251 7.58 .6631 Figure 2 demonstrates that SoonerCare Choice members remained fairly satisfied with the health care they received in 2010 compared with the ratings in 2008. The slight increase was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 11 Overall Rating for Personal Doctor • Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor in the last 6 months? Figure 3. Overall Rating for Personal Doctor 7.74 8.08 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 496 8.08 2008 249 7.74 .0833 Figure 3 shows that SoonerCare Choice members were highly satisfied with their personal doctor in 2010. The slight increase in satisfaction from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 12 Overall Rating for Specialist • We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist? Figure 4. Overall Rating for Specialist 8.00 8.39 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 247 8.39 2008 112 8.00 .1468 Figure 4 shows that SoonerCare Choice members were highly satisfied with their specialist doctor seen most often in 2010. The slight increase from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 13 Overall Rating for Health Plan • Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan? Figure 5. Overall Rating for Health Plan 7.59 7.82 0 1 2 3 4 5 6 7 8 9 10 2008 2010 Mean Year N Mean p-value 2010 569 7.82 2008 306 7.59 .1718 Figure 5 shows that SoonerCare Choice members were generally satisfied with their health plan in 2010. The increase from 2008 to 2010 was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 14 Composite Measures In Figures 6 through 9, composite measures for the following services are provided: • Experiences in getting treatment quickly • Experiences with how well clinicians communicate • Experiences with getting needed treatment • Experiences with health plan information and customer service These questions were answered on a four-point ordinal scale, where 1= “never,” 2 = “sometimes,” 3 = “usually,” and 4 = “always.” Responses of “never” and “sometimes” were combined into one category for the purpose of graphing since there were small percentages in those categories. The mean of the four-point scale was computed and compared between years using a t-test, following standard CAHPS analysis protocol. The percentage in each category for the composite measures is shown in the bar graph. The table below each graph lists the number of respondents analyzed, the mean and the p-value associated with the t-test comparison of means. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 15 Getting Treatment Quickly • In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed? • In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for health care at a doctor’s office or clinic as soon as you thought you needed? Figure 6. Getting Treatment Quickly 22.88% 18.24% 25.12% 22.18% 52.01% 59.58% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 523 3.38 2008 281 3.24 .0099 Figure 6 shows that 59.58% of the respondents in 2010 reported they always received treatment quickly. The difference of means from 2008 was statistically significant, as 52.01% of respondents in 2008 reported that they always received treatment quickly. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 16 How Well Clinicians Communicate • In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand? • In the last 6 months, how often did your personal doctor listen carefully to you? • In the last 6 months, how often did your personal doctor show respect for what you had to say? • In the last 6 months, how often did your personal doctor spend enough time with you? Figure 7. How Well Clinicians Communicate 19.61% 15.78% 22.06% 21.15% 58.33% 63.06% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 440 3.43 2008 226 3.34 .1233 Figure 7 indicates that 63.06% of members felt that their clinicians always communicated well during SFY 2010. This was an increase from 58.33% in SFY 2007; however, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 17 Getting Needed Health Care • In the last 6 months, how often was it easy to get appointments with specialists? • In the last 6 months, how often was it easy to get the care, tests, or treatment you thought you needed through your health plan? Figure 8. How Often Needed Health Care was Easy to Get 27.24% 22.18% 27.25% 27.71% 45.51% 50.11% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 409 3.21 2008 216 3.07 .5551 Figure 8 indicates that 50.11% of members felt that they always had easy access to specialists and needed treatment during SFY 2010. This was an increase from 45.51% in SFY 2008; however, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 18 Health Plan Information and Customer Service • In the last 6 months, how often did your health plan's customer service give you the information or help you needed? • In the last 6 months, how often did your health plan's customer service staff treat you with courtesy and respect? Figure 9. How Often Customer Service Gave Information, Courtesy, and Respect 12.06% 12.62% 22.36% 16.95% 65.58% 70.42% 0% 20% 40% 60% 80% 100% 2008 2010 Never/Sometimes Usually Always Year N Mean p-value 2010 128 3.26 2008 90 3.25 .8897 Figure 9 indicates that 70.42% of members felt that their clinicians always communicated well during SFY 2010. Although this was an increase from 65.58% in SFY 2008, the increase in average score was not statistically significant. CAHPS® Adult SoonerCare Choice Survey Fiscal Year 2010 June 2010 Page 19 Discussion The overall picture drawn by the CAHPS data is one of high and rising satisfaction with several different aspects of health care received from SoonerCare providers, and also customer services provided directly by SoonerCare. Positive trends were seen in ratings of health care, personal physicians, specialists, the health plan, and also in composite measures of getting care quickly, provider communication, getting needed care, and customer service. One measure increased enough to be statistically significant: respondents reported an increase in how often they were able to get care quickly. The SFY 2010 sampling methodology involved limiting the sampling frame to members who had a paid health claim. Using this method, the number of completed surveys increased by 89% when compared to SFY 2008. The increase in completed surveys also contributed to an adjusted response rate that was 89% higher than the previous year. It appears to be a successful method in that members utilizing SoonerCare services were more likely to have an opinion regarding their health care. APS recommends the OHCA continue to follow this sampling methodology for future surveys. Appendix A APPENDIX A CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 22 Appendix B Below are the responses for each survey question. There were 628 total completed questionnaires. Frequencies depicted in the tables reflect the number of people responding to each item; percentages depicted in the tables reflect the total number of respondents to the particular question. Non-responses or missing data are omitted from each table. 1. Our records show that you are now in SoonerCare Choice. Is that right? Q1 Frequency Percent Yes 625 100.00 3. In the last 6 months, did you have an illness, injury, or condition that needed care right away in a clinic, emergency room or doctor's office? Q3 Frequency Percent Yes 364 60.97 No 233 39.03 Total 597 100.00 4. In the last 6 months, when you needed care right away how often did you get care as soon as you thought you needed? Q4 Frequency Percent Never 13 3.61 Sometimes 48 13.33 Usually 81 22.50 Always 218 60.56 Total 360 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 23 5. In the last 6 months, not counting the times you needed care right away, did you make any appointments for your health care at a doctor's office or clinic? Q5 Frequency Percent Yes 479 80.64 No 115 19.36 Total 594 100.00 6. In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor's office or clinic as soon as you thought you needed? Q6 Frequency Percent Never 14 2.97 Sometimes 78 16.56 Usually 103 21.87 Always 276 58.60 Total 471 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 24 7. In the last 6 months, not counting times you went to an emergency room, how many times did you go to a doctor's office or clinic to get care for yourself? Q7 Frequency Percent 0 70 12.13 1 83 14.38 2 97 16.81 3 85 14.73 4 72 12.48 5 to 9 120 20.80 10 or more 50 8.67 Total 577 100.00 8. In the last 6 months, how often did you and a doctor or other health provider talk about specific things you could do to prevent illness? Q8 Frequency Percent Never 70 14.00 Sometimes 122 24.40 Usually 126 25.20 Always 182 36.40 Total 500 100.00 9. In the last 6 months, did a doctor or other health provider tell you there was more than one choice for your treatment or health care? Q9 Frequency Percent Yes 242 48.69 No 255 51.31 Total 497 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 25 10. In the last 6 months, did a doctor or other health provider talk with you about the pros and cons of each choice for your treatment or health care? Q10 Frequency Percent Definitely Yes 132 55.00 Somewhat Yes 84 35.00 Somewhat No 18 7.50 Definitely No 6 2.50 Total 240 100.00 11. In the last 6 months, when there was more than one choice for your treatment or health care, did a doctor or other health provider ask which choice you thought was best for you? Q11 Frequency Percent Definitely Yes 119 50.00 Somewhat Yes 94 39.50 Somewhat No 12 5.04 Definitely No 13 5.46 Total 238 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 26 12. Rating of all health care Q12 Frequency Percent 0 Worst 8 1.62 1 6 1.21 2 4 0.81 3 13 2.63 4 21 4.24 5 52 10.51 6 32 6.46 7 54 10.91 8 79 15.96 9 67 13.54 10 Best 159 32.12 Total 495 100.00 13. Do you have a personal doctor? Q13 Frequency Percent Yes 511 87.50 No 73 12.50 Total 584 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 27 14. In the last 6 months, how many times did you visit your personal doctor to get care for yourself? Q14 Frequency Percent 0 62 12.33 1 89 17.69 2 89 17.69 3 72 14.31 4 70 13.92 5 to 9 96 19.09 10 or more 25 4.97 Total 503 100.00 15. In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand? Q15 Frequency Percent Never 17 3.88 Sometimes 44 10.05 Usually 99 22.60 Always 278 63.47 Total 438 100.00 16. In the last 6 months, how often did your personal doctor listen carefully to you? Q16 Frequency Percent Never 19 4.35 Sometimes 56 12.81 Usually 85 19.45 Always 277 63.39 Total 437 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 28 17. In the last 6 months, how often did your personal doctor show respect for what you had to say? Q17 Frequency Percent Never 15 3.43 Sometimes 43 9.84 Usually 82 18.76 Always 297 67.96 Total 437 100.00 18. In the last 6 months, how often did your personal doctor spend enough time with you? Q18 Frequency Percent Never 22 5.03 Sometimes 60 13.73 Usually 104 23.80 Always 251 57.44 Total 437 100.00 19. In the last 6 months, did you get care from a doctor or other health provider besides your personal doctor? Q19 Frequency Percent Yes 288 65.90 No 149 34.10 Total 437 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 29 20. In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from these doctors or other health providers? Q20 Frequency Percent Never 34 12.06 Sometimes 48 17.02 Usually 73 25.89 Always 127 45.04 Total 282 100.00 21. Rating of personal doctor Q21 Frequency Percent 0 Worst 9 1.81 1 6 1.21 2 10 2.02 3 9 1.81 4 15 3.02 5 30 6.05 6 24 4.84 7 37 7.46 8 75 15.12 9 69 13.91 10 Best 212 42.74 Total 496 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 30 22. In the last 6 months, did you try to make any appointments to see a specialist? Q22 Frequency Percent Yes 275 47.66 No 302 52.34 Total 577 100.00 23. In the last 6 months, how often was it easy to get appointments with specialists? Q23 Frequency Percent Never 22 8.09 Sometimes 41 15.07 Usually 72 26.47 Always 137 50.37 Total 272 100.00 24. How many specialists have you seen in the last 6 months? Q24 Frequency Percent 0 24 8.79 1 142 52.01 2 57 20.88 3 27 9.89 4 14 5.13 5 9 3.30 Total 273 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 31 25. Rating of specialist saw most often Q25 Frequency Percent 0 Worst 2 0.81 1 1 0.40 2 5 2.02 3 5 2.02 4 8 3.24 5 9 3.64 6 18 7.29 7 14 5.67 8 24 9.72 9 38 15.38 10 Best 123 49.80 Total 247 100.00 26. In the last 6 months, did you try to get any kind of care, tests, or treatment through your health plan? Q26 Frequency Percent Yes 351 61.58 No 219 38.42 Total 570 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 32 27. In the last 6 months, how often was it easy to get care, tests, or treatment you thought you needed through your health plan? Q27 Frequency Percent Never 20 5.73 Sometimes 54 15.47 Usually 101 28.94 Always 174 49.86 Total 349 100.00 28. In the last 6 months, did you look for any information in written materials or on the Internet about how your health plan works? Q28 Frequency Percent Yes 91 15.77 No 486 84.23 Total 577 100.00 29. In the last 6 months, how often did the written materials or the Internet provide the information you needed about how your health plan works? Q29 Frequency Percent Never 4 4.49 Sometimes 22 24.72 Usually 33 37.08 Always 30 33.71 Total 89 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 33 30. In the last 6 months, did you try to get information or help from your health plan's customer service? Q30 Frequency Percent Yes 129 22.47 No 445 77.53 Total 574 100.00 31. In the last 6 months, how often did your health plan's customer service give you the information or help you needed? Q31 Frequency Percent Never 11 8.66 Sometimes 23 18.11 Usually 32 25.20 Always 61 48.03 Total 127 100.00 32. In the last 6 months, how often did your health plan's customer service staff treat you with courtesy and respect? Q32 Frequency Percent Never 9 7.20 Sometimes 12 9.60 Usually 27 21.60 Always 77 61.60 Total 125 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 34 33. In the last 6 months, did your health plan give you any forms to fill out? Q33 Frequency Percent Yes 125 22.08 No 441 77.92 Total 566 100.00 34. In the last 6 months, how often were the forms from your health plan easy to fill out? Q34 Frequency Percent Never 7 5.83 Sometimes 23 19.17 Usually 46 38.33 Always 44 36.67 Total 120 100.00 35. Rating of your health plan Q35 Frequency Percent 0 Worst 10 1.76 1 5 0.88 2 9 1.58 3 5 0.88 4 20 3.51 5 47 8.26 6 42 7.38 7 65 11.42 8 101 17.75 9 68 11.95 10 Best 197 34.62 Total 569 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 35 36. In general, how would you rate your overall health? Q36 Frequency Percent Excellent 38 6.55 Very Good 88 15.17 Good 172 29.66 Fair 180 31.03 Poor 102 17.59 Total 580 100.00 37. Do you now smoke cigarettes or use tobacco every day, some days, or not at all? Q37 Frequency Percent Every day 191 32.76 Some days 74 12.69 Not at all 305 52.32 Don’t know 13 2.23 Total 583 100.00 38. In the last 6 months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider in your plan? Q38 Frequency Percent Never 58 22.14 Sometimes 65 24.81 Usually 48 18.32 Always 91 34.73 Total 262 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 36 39. In the last 6 months, how often was medication recommended or discussed by a doctor or health provider to assist you with quitting smoking or using tobacco? Q39 Frequency Percent Never 127 49.22 Sometimes 64 24.81 Usually 29 11.24 Always 38 14.73 Total 258 100.00 40. In the last 6 months, how often did your doctor or health provider discuss or provide methods and strategies other than medication to assist you with quitting smoking or using tobacco? Q40 Frequency Percent Never 156 61.18 Sometimes 49 19.22 Usually 21 8.24 Always 29 11.37 Total 255 100.00 41. Do you take aspirin daily or every other day? Q41 Frequency Percent Yes 162 28.52 No 406 71.48 Total 568 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 37 42. Do you have a health problem or take medication that makes taking aspirin unsafe for you? Q42 Frequency Percent Yes 81 16.30 No 416 83.70 Total 497 100.00 43. Has a doctor or health provider ever discussed with you the risks and benefits of aspirin to prevent heart attack or stroke? Q43 Frequency Percent Yes 237 41.22 No 338 58.78 Total 575 100.00 44. Are you aware that you have any of the following conditions? High cholesterol Q44A Frequency Percent No 441 70.22 Yes 187 29.78 Total 628 100.00 44. Are you aware that you have any of the following conditions? High blood pressure Q44B Frequency Percent No 374 59.55 Yes 254 40.45 Total 628 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 38 44. Are you aware that you have any of the following conditions? Parent or sibling with heart attack before the age of 60 Q44C Frequency Percent No 479 76.27 Yes 149 23.73 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? A heart attack Q45A Frequency Percent No 577 91.88 Yes 51 8.12 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? Angina or coronary heart disease Q45B Frequency Percent No 577 91.88 Yes 51 8.12 Total 628 100.00 45. Has a doctor ever told you that you have any of the following conditions? A stroke Q45C Frequency Percent No 578 92.04 Yes 50 7.96 Total 628 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 39 45. Has a doctor ever told you that you have any of the following conditions? Any kind of diabetes or high blood sugar Q45D Frequency Percent No 481 76.59 Yes 147 23.41 Total 628 100.00 46. In the last 6 months, have you seen a doctor or other health provider 3 or more times for the same condition or problem? Q46 Frequency Percent Yes 322 55.23 No 261 44.77 Total 583 100.00 47. Is this a condition or problem that has lasted for at least 3 months? Do not include pregnancy or menopause. Q47 Frequency Percent Yes 270 86.26 No 43 13.74 Total 313 100.00 48. Do you now need or take medicine prescribed by a doctor? Do not include birth control. Q48 Frequency Percent Yes 477 81.82 No 106 18.18 Total 583 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 40 49. Is this to treat a condition that has lasted for at least 3 months? Do not include pregnancy or menopause. Q49 Frequency Percent Yes 428 92.04 No 37 7.96 Total 465 100.00 50. What is your age? Q50 Frequency Percent 18-24 107 18.26 25-34 73 12.46 35-44 99 16.89 45-54 169 28.84 55-64 135 23.04 65-74 3 0.51 Total 586 100.00 51. Are you male or female? Q51 Frequency Percent Male 187 32.13 Female 395 67.87 Total 582 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 41 52. What is the highest grade or level of school that you have completed? Q52 Frequency Percent 8th grade or less 44 7.61 Some high school 156 26.99 HS grad or GED 229 39.62 Some college 131 22.66 College grad 15 2.60 More than 4yr college 3 0.52 Total 578 100.00 53. Are you of Hispanic or Latino origin or descent? Q53 Frequency Percent Yes 30 5.49 No 516 94.51 Total 546 100.00 54. What is your race? Q54 Frequency Percent White 379 65.57 Black or African American 78 13.49 American Indian or Alaska Native1 46 7.96 Multiracial / Other2 75 12.98 Total 578 100.00 1The race categories are based upon the standard CMS nomenclature for all Medicaid programs. 2Respondents who selected more than one race were grouped in the multiracial / other category. CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 42 55. Did someone help you complete this survey? Q55 Frequency Percent Yes 114 24.20 No 357 75.80 Total 471 100.00 56. How did that person help you? Read the questions to me Q56A Frequency Percent No 47 41.23 Yes 67 58.77 Total 114 100.00 56. How did that person help you? Wrote down the answers I gave Q56B Frequency Percent No 69 60.53 Yes 45 39.47 Total 114 100.00 56. How did that person help you? Answered the questions for me Q56C Frequency Percent No 81 71.05 Yes 33 28.95 Total 114 100.00 CAHPS® Adult Medicaid Survey Fiscal Year 2010 June 2010 Page 43 56. How did that person help you? Translated the questions into my language Q56D Frequency Percent No 108 94.74 Yes 6 5.26 Total 114 100.00 56. How did that person help you? Helped in some other way Q56E Frequency Percent No 103 90.35 Yes 11 9.65 Total 114 100.00 |
Date created | 2011-11-30 |
Date modified | 2011-11-30 |