Dating back to the first phase of the CAHPS program (1996 - 2000), the CAHPS Consortium has recognized the need for a standardized, evidence-based instrument that would enable clinicians and administrators to assess and improve patients' experiences with medical groups and clinicians. Working in collaboration with the Pacific Business Group on Health, whose Consumer Assessment Survey established a precedent for this type of instrument, the Consortium developed a preliminary instrument known as the CAHPS Group Practices Survey (G-CAHPS).
One of the driving principles behind the CAHPS program has been close collaboration with key stakeholders, including accrediting bodies, major provider and health plan associations, purchasers, and consumer representatives. When the CAHPS II program began, the grantees sought input from stakeholders in order to determine how to best proceed with a provider-level survey. They interviewed a variety of people about their experiences with the Health Plan Survey and their information eeds with respect to both clinicians and groups. The insights gleaned from these interviews played a major role in shaping the development of waht became known as the Ambulatory Care CAHPS (A-CAHPS) initiative, whose goal has been to broaden the program's focus to encompass multiple levels of ambulatory care.
To continue getting that kind of valuable input, the CAHPS Consortium established the A-CAHPS Advistory Group, whose members have been participating in the development process on an ongoing basis by providing input into both content issues as well as survey administration issues. This feedback has helped ensure that the survey results for each level of the health care system reflect functions that are truly under their control.
The A-CAHPS Advisory Group includes members of organizations that work closely with medical groups and clinicians, such as the American Board of Medical Socities, the American Board of Internal Medicine, the American Medical Group Association, and the Medical Group Management Association. Input from these organizations proved crucial to the Ambulatory CAHPS Team as it refined the CAHPS Clinician & Group Survey.
Once the A-CAHPS Team had developed an initial draft of the Clinician & Group Survey, they were ready to test it in the field. On August 18, 2004, the Agency for Healthcare Research & Quality (AHRQ) issued a notice in the Federal Register inviting organizations to test this instrument. Over a dozen organizations administered a version of the Clinician & Group Survey to patients, providing data on a host of different issues for the A-CAHPS Team to analyze. These field test organiations were crucial partners in the evolution and development of the instrument, and continue to provide critical data illuminating key aspects of survey design and administration.
In the spring of 2005, the CAHPS development team conducted one round of 29 English-language cognitive interviews in Massachusetts and California to gague how potential respondents understand and interpret the survey questions. The results of those interviews informed the development of a May 2005 field test instrument. By August 2005, that version was further refined to incorporate feedback from the A-CAHPS Advistory. A follow-up round of nine English-language cognitive interviews was completed in September 2005, followed by additional Spanish-language interviews.
In July 2006, AHRQ submitted the Clinician & Group Survey to the National Quality Forum (NQF) as a measure of patient experience with ambulatory care. Since that time, the CAHPS Consoritum has been working with NQF to adjust the survey, as well as sampling and administration guidelines, in order to address members' concerns. AHRQ expects NQF to endorse the instrument in November 2007.
