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  • Measure Summary
  • NQMC:007399
  • Sep 2011

Patients' experiences: percentage of respondents who reported how often their family member's nursing home provided appropriate staffing, care of belongings, and cleanliness.

CAHPS® Nursing Home Survey. Version: Family Member Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 10 p.
Patient experience measures for the CAHPS® Nursing Home Surveys. Document no. 609. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 8 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in July 2015.

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 respondents who reported how often their family member's nursing home provided appropriate staffing, care of belongings, and cleanliness.

This "Nursing Home Staffing, Care of Belongings, and Cleanliness" composite measure is based on seven questions in the CAHPS Nursing Home Family Member Survey. Five questions ask respondents (defined as family members of nursing home residents) how often ("Never," "Sometimes," "Usually," "Always"):

  • Can find a nurse or aide
  • Enough nurses/aides
  • Room looks/smells clean
  • Resident looks/ smells clean
  • Public areas look/smell clean

AND

One question asks respondents how often ("Never," "Once," "2+ times"):

  • Family member's personal medical belongings lost

AND

One question asks respondents how often ("Never," "Once or twice," "3+ times"):

  • Family member's clothes damaged or lost

The Family Member Survey asks respondents to report on their own experiences (not the resident's) with the nursing home and their perceptions of the quality of care provided to a family member living in a nursing home. This instrument is designed to be administered by mail.

Note: A composite score is calculated in which a higher score indicates better quality. Composite scores are intended for consumer-level (nursing home) reporting.

Rationale

The CAHPS Nursing Home Surveys include three instruments designed to provide information on the experiences of nursing home residents and their family members. Multiple versions of the Nursing Home Surveys are available to meet different needs:

  • Long-Stay Resident Survey
  • Discharged Resident
  • Family Member Survey

The Nursing Home Surveys can be used in monitoring programs designed to improve both care quality and patient satisfaction.

Although the family members do not receive care from the nursing home, their experiences at the nursing home and with staff are important in describing the quality of the nursing home. Family members often help choose the nursing home and continue to be involved with their family member after entry, participating in care planning and making decisions on behalf of the resident. Like the CAHPS Nursing Home Resident Surveys, the family reported experiences of care complement other, publicly reported data such as health deficiencies, staffing, and other quality indicators (e.g., percent of residents with restraints), and thus contribute to providing a comprehensive view of quality care.

The Centers for Medicare & Medicaid Services requested development of this questionnaire to complement the Long-Stay Resident Instrument especially for those residents who may be too impaired to respond for themselves.

Evidence for Rationale

American Institutes for Research. Frentzel E, Evensen C, Keller S, Garfinkel SA. CAHPS survey for family members of nursing home residents. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jul. 39 p.

CAHPS®. Nursing home family member survey. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Nov 17 [accessed 2012 Jun 01]. [1 p].

CAHPS®. Read about the nursing home surveys. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar 2 [accessed 2012 Jun 01]. [4 p].

Calikoglu S, Christmyer CS, Kozlowski BU. My eyes, your eyes--the relationship between CMS five-star rating of nursing homes and family rating of experience of care in Maryland. J Healthc Qual. 2012 Nov-Dec;34(6):5-12. PubMed External Web Site Policy

Frentzel EM, Sangl JA, Evensen CT, Cosenza C, Brown JA, Keller S, Garfinkel SA. Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences. Med Care. 2012 Nov;50 Suppl:S20-7. PubMed External Web Site Policy

Primary Health Components

Nursing home; family member/patient experience; staffing; care of belongings; cleanliness

Denominator Description

All respondents (defined as family members of nursing home residents) who answered the "Nursing Home Staffing, Care of Belongings, and Cleanliness" questions on the CAHPS Nursing Home Family Member Survey

Numerator Description

The number of "Never," "Sometimes," "Usually," "Always" and "Once," "Once or Twice," "2+ times," "3+ times" responses on the "Nursing Home Staffing, Care of Belongings, and Cleanliness" questions (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • Focus groups

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Development of the CAHPS Family Member Survey included:

  • Cognitive testing of survey questions. In 2005 and 2006, the items in this instrument went through two rounds of cognitive testing (n=54) with people who have family members in nursing homes. Persons were selected so as to assure variation in race, ethnicity, and education. Trained cognitive interviewers conducted one-on-one, in-person interviews. Using a "think-aloud" approach for the interviews, participants were asked to read each question (or read the question verbally to the participant), provide a verbal response, and explain the reason for the response. Interviewers then followed up with probes after each of the questions to ask about specific potential problems with each item. Immediately after each interview, the interviewer wrote a summary of the participant's comments. A member of each grantee team reviewed these summaries and extracted common themes for each item. At the end of each round, the team met to review these themes and make recommendations to the larger family survey team. The larger team made decisions together regarding each of the items.
  • Field testing. With the assistance of the Texas State Long Term Care Ombudsman, the CAHPS Team conducted a field test at 15 nursing homes in Texas between October 2006 and January 2007. Additionally, the Health Quality Council of Alberta conducted an independent field test with 14 nursing homes in Alberta, Canada, and contributed their data for the psychometric analyses. Analyses were done both jointly and separately. Data from the pilot survey (n=885) were subjected to psychometric analyses to evaluate the measurement properties of items as well as the reliability and validity of the resulting composites. On the basis of these analyses and input from experts, the survey was finalize.

Evidence for Extent of Measure Testing

American Institutes for Research. Frentzel E, Evensen C, Keller S, Garfinkel SA. CAHPS survey for family members of nursing home residents. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jul. 39 p.

CAHPS®. Development of the family member survey. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Nov 17 [accessed 2012 Jun 01]. [2 p].

Frentzel EM, Sangl JA, Evensen CT, Cosenza C, Brown JA, Keller S, Garfinkel SA. Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences. Med Care. 2012 Nov;50 Suppl:S20-7. PubMed External Web Site Policy

State of Use

Current routine use

Current Use

Decision-making by consumers about health plan/provider choice

External oversight/State government program

Internal quality improvement

Public reporting

Professionals Involved in Delivery of Health Services

Allied Health Personnel

Clinical Administrators/Managers

Nurses

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 greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care

IOM Care Need

End of Life Care

Living with Illness

Staying Healthy

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All respondents (defined as family members of nursing home residents) who answered the "Nursing Home Staffing, Care of Belongings, and Cleanliness" questions on the CAHPS Nursing Home Family Member Survey

Exclusions
Exclude family member respondents (1) who are under age 18, (2) who did not visit the nursing home resident at least twice in 6 months, (3) whose resident was discharged, and (4) those with a resident who had been in the nursing home for less than or equal to 100 days.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The number of "Never," "Sometimes," "Usually," "Always" and "Once," "Once or Twice," "2+ times," "3+ times" responses on the "Nursing Home Staffing, Care of Belongings, and Cleanliness" questions

From the responses, a composite score is calculated in which a higher score indicates better quality.

Note: Refer to Instructions for Analyzing Data from CAHPS Surveys in the "Companion Documents" field for additional information regarding data analysis.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

CAHPS Nursing Home Family Member Survey

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Weighted Score

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

The CAHPS Team recommends adjusting the survey data for respondent age, education, and general health status. This makes it more likely that reported differences are due to real differences in performance, rather than differences in the characteristics of enrollees or patients.

The CAHPS team recommends four items to be case-mix adjusters for the CAHPS Nursing Home Family Survey: 1) respondent age, 2) respondent education, 3) whether the respondent believes the resident will permanently live in the nursing home, and 4) respondent's belief about whether the resident was capable of making decisions. Several additional items were considered as potential adjusters but were rejected for a variety of reasons. Refer to the CAHPS Survey for Family Members of Nursing Home Residents Final Report in the "Companion Documents" field for a full description of the risk adjustment process.

CAHPS recommends adjusting for the case-mix of the patients who evaluated each provider to allow comparison of scores across providers.

Refer to the original measure documentation for additional information on case-mix adjustment.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Nursing home staffing, care of belongings, and cleanliness.

Measure Collection Name

CAHPS Nursing Home Survey

Measure Set Name

Family Member Survey

Submitter

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

Developer

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

American Institutes for Research - Academic Affiliated Research Institute

CAHPS Consortium - Health Care Quality Collaboration

Harvard University - Academic Institution

Funding Source(s)

  • Agency for Healthcare Research and Quality (AHRQ)
  • Centers for Medicare & Medicaid Services (CMS)

Composition of the Group that Developed the Measure

Agency for Healthcare Research and Quality (AHRQ) established a Technical Expert Panel (TEP) comprised of industry, regulators and quality improvement organizations, payers, long-term care researchers and consumer advocates. In addition to the Centers for Medicare & Medicaid Services (CMS), the TEP included representatives from AARP, American Health Care Association, American Association of Home and Services for the Aged (now Leading Age), National Alliance for Caregivers/Gerontology Program of Towson University, Quality Partners of Rhode Island, Veterans Administration (VA), National Citizens Coalition for Nursing Home Reform (now Consumer Voice for LTC), Scripps Gerontology Center of Miami University, Alzheimer's Association, American Medical Directors Association, and National Network of Career Nursing Assistants.

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2011 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in July 2015.

Source(s)

CAHPS® Nursing Home Survey. Version: Family Member Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 10 p.

Patient experience measures for the CAHPS® Nursing Home Surveys. Document no. 609. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 8 p.

Measure Availability

CAHPS Nursing Home Family Member Survey available from the CAHPS Web site External Web Site Policy.

For more information, contact CAHPS Technical Assistance.

Companion Documents

The following is available:

  • Instructions for analyzing data from CAHPS surveys: using the CAHPS analysis program version 4.0. Document no. 2015. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 75 p.
  • Frentzel EM, Sangl JA, Evensen CT, Cosenza C, Brown JA, Keller S, Garfinkel SA. Giving voice to the vulnerable: the development of a CAHPS nursing home survey measuring family members' experiences. Med Care. 2012 Nov;50 Suppl:S20-7.
  • American Institutes for Research. Frentzel E, Evensen C, Keller S, Garfinkel SA. CAHPS survey for family members of nursing home residents. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jul. 39 p.

For more information, contact CAHPS Technical Assistance.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 22, 2013. The information was verified by the measure developer on April 24, 2013.

The information was reaffirmed by the measure developer on July 23, 2015.

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