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  • Measure Summary
  • NQMC:010085
  • Dec 2014
  • NQF-Endorsed Measure

Hospital inpatients' experiences: percentage of parents who reported how often the room and bathroom were kept clean.

CAHPS® Hospital Surveys: child version. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Dec 9. 13 p.
Consumer Assessment of Healthcare Providers and Systems Hospital Survey -- child version (Child HCAHPS): appendix. Boston (MA): Boston Children's Hospital; 2014 May. 122 p.
Patient experience measures from the CAHPS® Child Hospital Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Dec 23. 15 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Patient Experience

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients whose parents/guardians (henceforth referred to as parent) reported how often ("Never," "Sometimes," "Usually," "Always") the room and bathroom were kept clean.

The "Cleanliness of Hospital Room" measure is based on one item on the Child Hospital CAHPS (Child HCAHPS) Survey.

Rationale

The Child Hospital CAHPS (Child HCAHPS) Survey assesses the experiences of pediatric patients (age 17 and younger) with inpatient health care received in a hospital. Child HCAHPS asks parents about communication with doctors, communication with nurses, hospital environment, age-appropriateness of care, pain management, and other domains that parents viewed as important aspects of their child's care. By gathering this information, the survey addresses the need to assess and improve the experiences of pediatric inpatients and their parents.

The survey results are expected to be useful to everyone with a need for information on the quality of pediatric inpatient care, including patients, parents, hospitals, health plans, insurers, and policy makers:

  1. Patients and parents can use the information to help make better and more informed choices about inpatient care.
  2. Hospitals, health plans, insurers, and policy makers can use the survey results for quality improvement initiatives. To learn more about using the survey for quality improvement, go to Improve Patients' Experiences with Hospitals.

Child HCAHPS complements the Adult Hospital CAHPS (Adult HCAHPS) Survey, allowing for patients' hospital experiences to be assessed across the age continuum. Child HCAHPS is harmonized with many of the domains covered in Adult HCAHPS and also includes domains that are particularly relevant to pediatric care, such as how well providers involve teens in their care.

Evidence for Rationale

CAHPS® Child Hospital Survey: overview of the questionnaire. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Sept 22. 10 p.

Primary Health Components

Inpatient care; patient experience; cleanliness of hospital room; children

Denominator Description

Hospital inpatients with an admission during the reporting period whose parent answered the "Cleanliness of Hospital Room" item on the Child Hospital CAHPS (Child HCAHPS) Survey (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of "Always" responses on the "Cleanliness of Hospital Room" item on the Child Hospital CAHPS (Child HCAHPS) Survey (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • Focus groups

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP) identified the need for a standardized survey to assess the experiences of pediatric patients and their families with inpatient hospital care. Consequently, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) funded the Center of Excellence for Pediatric Quality Measurement at Boston Children's Hospital (CEPQM) and assigned it to develop and test a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey for children. CEPQM worked with the CAHPS Consortium to pursue this effort with the same emphasis on standardization and scientific rigor that characterize all CAHPS products and surveys.

Development of the Child Hospital CAHPS (Child HCAHPS) Survey occurred from 2011 to 2014 and included:

  • Focus groups. The survey development team conducted six focus groups with parents of recently hospitalized children and two with recently hospitalized adolescents in Boston, Los Angeles, and St. Louis. Two of these groups were conducted with parents of children with special health care needs. Focus groups were conducted in both English and Spanish and covered several aspects of care important to patients and families.
  • Cognitive testing. The survey development team conducted 109 in-depth cognitive interviews in Boston, Los Angeles, Miami, and St. Louis in English and Spanish. The survey developers revised the instrument in response to findings from the interviews, resulting in a 78-item questionnaire used for pilot testing.
  • Pilot testing. The survey development team conducted a pilot test of the draft survey in English and Spanish in eight hospitals across the country. Further survey revision and cognitive interviews led to a 66-item revised draft instrument.
  • Field testing. The survey development team tested the revised draft instrument with parents of recently hospitalized children in 69 hospitals across 34 states. The survey was fielded in both English and Spanish by either mail or phone. Based on comprehensive psychometric analyses of the field test data, the survey team made revisions to the questionnaire.
  • End-user testing. The survey development team conducted 23 cognitive interviews with parents in Atlanta and the Washington, D.C., area to test the understandability and usefulness of preliminary composite measure concepts and labels. Based on the findings from these interviews, the team refined the list of 18 composite, single-item, and rating measures and modified their labels.

Evidence for Extent of Measure Testing

CAHPS® Child Hospital Survey: overview of the questionnaire. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Sept 22. 10 p.

Toomey SL, Zaslavsky AM, Elliot MN, Gallagher PM, Fowler FJ, Klein DJ, Shulman S, Ratner J, McGovern C, LeBlanc JL, Schuster MA. The development of a pediatric inpatient experience of care measure: Child HCAHPS®. Pediatrics. 2015 Aug;136(2):360-9. [28 references] PubMed External Web Site Policy

State of Use

Current routine use

Current Use

External oversight/Health plans

Internal quality improvement

Quality of care research

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age less than or equal to 17 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window follows index event

Denominator Inclusions/Exclusions

Inclusions

  • Child under 18 years old at time of discharge
  • Admission includes at least one overnight stay in the hospital
    • An overnight stay is defined as an inpatient admission in which the patient's admission date is different from the patient's discharge date. The admission need not be 24 hours in length. For example, a patient would be considered to have had an overnight stay if he or she was admitted at 11:00 PM on Day 1 and discharged at 10:00 AM on Day 2. Patients who did not have an overnight stay should not be included in the sample frame (e.g., patients admitted for a short period of time solely for observation; patients admitted for same-day diagnostic tests as part of outpatient care).
  • Non-psychiatric Medicare severity-diagnosis related group (MS-DRG)/principal diagnosis at discharge
  • Alive at the time of discharge

Exclusions

  • "No-publicity" patients – Patients who request that they not be contacted
  • Court/law enforcement patients (i.e., prisoners); this category does not include patients residing in halfway houses
  • Patients with a foreign home address (the U.S. territories—American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and Virgin Islands—are not considered foreign addresses and therefore, are not excluded)
  • Patients discharged to hospice care (hospice-home or hospice-medical facility)
  • Patients who are excluded because of state regulations
  • Patients who are wards of the state
  • Healthy newborns
  • Patients admitted for obstetric care
  • Observation patients
  • Patients who are emancipated minors
  • Patients discharged to skilled nursing facilities

Note: Patients should be included in the Child Hospital CAHPS (Child HCAHPS) Survey sample frame unless the hospital/survey vendor has positive evidence that a patient is ineligible or fits within an excluded category. If no information is missing on any variable that affects survey eligibility when the sample frame is constructed, the patient must be included in the sample frame.

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
The number of "Always" responses (i.e., top box) on the "Cleanliness of Hospital Room" item on the Child Hospital CAHPS (Child HCAHPS) Survey

Note:

  • Top box score is the percentage of survey respondents who chose the most positive response for a given item response scale (i.e., "Always").
  • Refer to the Consumer Assessment of Healthcare Providers and Systems Hospital Survey—Child Version (Child HCAHPS): Appendix document for information on producing hospital scores.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Child Hospital CAHPS® (Child HCAHPS) Survey

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Case-mix adjustment

Description of Allowance for Patient or Population Factors

When comparing hospitals, it is necessary to adjust appropriately for case-mix differences. Case-mix refers to patient characteristics, such as demographic characteristics and health status, that are not under the control of the hospital and may affect scores on performance measures. Systematic effects of this sort create the potential for a hospital's rating to be higher or lower because of characteristics of its patient population rather than the quality of care it provides. Comparisons of unadjusted scores may therefore be misleading. The basic goal of adjusting for case mix is to estimate how different hospitals would score if they all provided care to comparable groups of patients.

Analyses of the Child Hospital CAHPS (Child HCAHPS) Survey pilot data were conducted to examine the effects of patients' characteristics on parent report of hospital care. Child HCAHPS includes adjustment of hospital scores for patient characteristics that are associated with Child HCAHPS measures and are differentially distributed across hospitals. The case-mix data are obtained from items in the "About You" section of the survey and from hospital administrative records. Based on findings from the pilot data analyses and consistent with previous studies of case-mix adjustment in CAHPS and other hospital patient surveys, Child HCAHPS uses the following categorical variables in the case-mix adjustment model:

  • Child age
  • Child global health status
  • Respondent age
  • Respondent education
  • Respondent relationship to child
  • Language preference

Refer to the Instructions for Analyzing Data from CAHPS® Surveys document (see also the "Companion Documents" field) for additional information.

Standard of Comparison

Internal time comparison

Original Title

Cleanliness of hospital room.

Measure Collection Name

Child Hospital CAHPS (Child HCAHPS) Survey

Submitter

Center of Excellence for Pediatric Quality Measurement, Boston Children's Hospital - Hospital/Medical Center

Developer

Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]

CAHPS Consortium - Health Care Quality Collaboration

Center of Excellence for Pediatric Quality Measurement, Boston Children's Hospital - Hospital/Medical Center

Funding Source(s)

Funding was provided by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) through the Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP).

Composition of the Group that Developed the Measure

  • Marc N. Elliott, PhD
  • Floyd J. Fowler, Jr., PhD
  • Patricia M. Gallagher, PhD
  • Mark A. Schuster, MD, PhD (Director, Center of Excellence for Pediatric Quality Measurement [CEPQM]; Co-lead, Child Hospital CAHPS [Child HCAHPS])
  • Sara L. Toomey, MD, MPhil, MPH, MSc (Managing Director, CEPQM; Co-lead, Child HCAHPS)
  • Alan M. Zaslavsky, PhD
  • Staff of the CEPQM at Boston Children's Hospital
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) Consortium

Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser

National Quality Forum

NQF Number

2548

Date of Endorsement

2015 Jan 7

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2014 Dec

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

CAHPS® Hospital Surveys: child version. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Dec 9. 13 p.

Consumer Assessment of Healthcare Providers and Systems Hospital Survey -- child version (Child HCAHPS): appendix. Boston (MA): Boston Children's Hospital; 2014 May. 122 p.

Patient experience measures from the CAHPS® Child Hospital Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 Dec 23. 15 p.

Measure Availability

CAHPS® Hospital Surveys: Child Version available from the CAHPS Web site External Web Site Policy.

For more information, contact CAHPS Technical Assistance at E-mail: cahps1@westat.com; Phone: 1-800-492-9261.

Companion Documents

The following are available:

  • Instructions for analyzing data from CAHPS surveys: using the CAHPS analysis program version 4.1. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Apr 2. 74 p. This document is available from the CAHPS Web site External Web Site Policy.
  • Agency for Healthcare Research and Quality (AHRQ). Consumer Assessment of Healthcare Providers and Systems Hospital Survey -- child version (Child HCAHPS). Washington (DC): National Quality Forum (NQF); 2014 May 22. various p.

For more information, contact the CAHPS User Network at E-mail: cahps1@westat.com; Phone: 1-800-492-9261.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 11, 2015. The information was verified by the measure developer on September 25, 2015.

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No copyright restrictions apply.

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