Measuring Patient Satisfaction: Low Literacy Populations

摘要

The Consumer Assessment of Health Plans Study (CAHPS(trademark)) survey is widely used for assessing patient satisfaction in vulnerable groups, such as Medicaid members. We developed two alternative formats for the CAHPS survey designed to make it more accessible to low-literacy populations. Goals included: (1) developing an illustrated version of the CAHPS(trademark)2.OH; (2) developing an interactive voice response (IVR) version of CAHPS(trademark)2.OH; (3) testing the acceptability and psychometric properties of these CAHPS(trademark) formats; and (4) comparing, in a randomized controlled trial, alternatives for administering the survey: the existing CAHPS(trademark), an illustrated version, and the existing CAHPS(trademark) with an IVRI option. Spanish and English versions were created. The study population was comprised of adults drawn zfrom a Medicaid or Medicare managed care population. Using primarily one-on-one interviews with patients waiting for clinic appointments, prototypes were tested among more than 900 participants. Scores were assessed for data quality, reliability, and validity among over 2000 clinic patients. Health literacy was estimated with the short-form TOFHLA. The four-aim randomized trial included 4800 Medicaid members. Illustrated and telephone (IVRI) formats were understood and well-liked. Item quality data and satisfaction scores were nearly identical for the traditional print and illustrated formats. Quality was better for the IVRI format, but satisfaction scores were significantly worse. Health literacy was one of the strangest and most consistent predictors of satisfaction scores. Response rates were significantly lower for the IVRI only arm of the randomized trial.