Skip to main content
Log in

Evaluating the Content of the Communication Items in the CAHPS® Clinician and Group Survey and Supplemental Items with What High-Performing Physicians Say They Do

  • Original Research Article
  • Published:
The Patient - Patient-Centered Outcomes Research Aims and scope Submit manuscript

Abstract

Background

A doctor’s ability to communicate effectively is key to establishing and maintaining positive doctor–patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS®) Clinician and Group Survey is the standard for collecting and reporting information about patients’ experiences of care in the USA.

Objective

To evaluate how well CAHPS® Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor–patient communication.

Data Sources/Study Setting

Eleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan.

Study Design

Data were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items.

Principal Findings

CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients.

Conclusions

CG-CAHPS survey items capture many of the most commonly mentioned doctor–patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor–patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients’ perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor–patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor–patient communication and interactions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ong LM, DeHaes JC, Hoos AM, Lammes FB. Doctor–patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18.

    Article  PubMed  CAS  Google Scholar 

  2. Anderson LA, Sharpe PA. Improving patient and provider communication: a synthesis and review of communication interventions. Patient Educ Couns. 1991;17:99–134.

    Article  Google Scholar 

  3. Hulsman RL, Ros WJG, Winnubst JAM, et al. Teaching clinically experienced physicians’ communication skills: a review of evaluation studies. Med Educ. 1999;33:655–68.

    Article  PubMed  CAS  Google Scholar 

  4. Marvel MK, Epstein RM, Flowers K. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7.

    Article  PubMed  CAS  Google Scholar 

  5. Marvel MK, Schilling R, Doherty WJ, et al. Levels of physician involvement with patients and their families: a model for teaching and research. J Fam Pract. 1994;39(6):535–44.

    PubMed  CAS  Google Scholar 

  6. Frankel RM, Stein T. Getting the most out of the clinical encounter: the four habits model. Perm J. 1999;3(3):79–88.

    Google Scholar 

  7. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25–38.

    PubMed  Google Scholar 

  8. Epstein RM, Franks P, Fiscella K, et al. Measuring patient-centered communication in doctor–patient consultations: theoretical and practical issues. Soc Sci Med. 2005;61(7):1516–28.

    Article  PubMed  Google Scholar 

  9. Beach MC, Inui T. Relationship-centered care. A constructive reframing. JGIM. 2006;21(Supp 1):S3–8.

    Article  PubMed  Google Scholar 

  10. Roter DL. Patient participation in patient provider interaction: the effects of patient question asking on the quality of interaction, satisfaction, and compliance. Health Educ Monogr. 1977;5:281–315.

    Article  PubMed  CAS  Google Scholar 

  11. Bartlet EE, Gravson M, Barker R. The effects of physician communication skills on patient satisfaction, recall, and adherence. J Chronic Dis. 1984;37:753–64.

    Article  Google Scholar 

  12. Franks P, Jerant AF, Fiscella K, et al. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators. Soc Sci Med. 2006;62(2):422–32.

    Article  PubMed  Google Scholar 

  13. Hargraves JL, Hays RD, Cleary PD. Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 Adult Core Survey. Health Serv Res. 2003;38:1509–27.

    Article  PubMed  Google Scholar 

  14. Tallman K, Janisse T, Frankel RM, et al. Communication practices of physicians with high patient-satisfaction ratings. Perm J. 2007;11(1):19–29.

    Article  PubMed  Google Scholar 

  15. Ruiz-Moral R, Perez Rodriquez E, Perula de Torres LA, et al. Physician-patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns. 2006;64:242–8.

    Article  PubMed  Google Scholar 

  16. Sofaer S, Crofton C, Goldstein E, et al. What do consumers want to know about the quality of care in hospitals? Health Serv Res. 2005;40:2018–36.

    Article  PubMed  Google Scholar 

  17. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.

    PubMed  CAS  Google Scholar 

  18. Stewart MA, Brown JB, Boon H, et al. Evidence on doctor–patient communication. Cancer Prev Control. 1999;3(1):25–30.

    PubMed  CAS  Google Scholar 

  19. Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet. 2001;357(9258):757–62.

    Article  PubMed  Google Scholar 

  20. Nagy VT. Clinician-patient communication: its big impact on health. Perm J. 2001;5(4).

  21. Greenfield S, Kaplan SH, Ware JE. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. JGIM. 1988;3:448–57.

    Article  PubMed  CAS  Google Scholar 

  22. Roter DL, Hall JA. Doctors talking with patients, patients talking with doctors. Westport: Auburn House; 1992.

    Google Scholar 

  23. Darby C, Hays RD, Kletke P. Development and evaluation of the CAHPS® Hospital Survey. Health Serv Res. 2005;40(6):1973–6.

    Article  PubMed  Google Scholar 

  24. Goldstein E, Farquhar M, Crofton C, et al. Measuring hospital care from the patients’ perspective: an overview of the CAHPS® Hospital Survey development process. Health Serv Res. 2005;40(6):1977–95.

    Article  PubMed  Google Scholar 

  25. Agency for Healthcare Research and Quality. The CAHPS® Connection 3(2). AHRQ Publication No. 07-0005-2-EF; 2007.

  26. Solomon LS, Hays RD, Zaslavsky AM, Ding L, Cleary PD. Psychometric properties of a group-level Consumer Assessment of Health Plans Study (CAHPS) Instrument. Med Care. 2005;43(1):53–60.

    PubMed  Google Scholar 

  27. O’Malley AJ, Zaslavsky AM, Elliott MN, et al. Case-mix adjustment of the CAHPS® Hospital Survey. Health Serv Res. 2005;40(6):2162–81.

    Article  PubMed  Google Scholar 

  28. Martino SC, Elliott MN, Cleary PD, et al. Psychometric properties of an instrument to assess Medicare beneficiaries’ prescription drug plan experiences. Health Care Financ Rev. 2009;30(3):41–53.

    PubMed  Google Scholar 

  29. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15:85–109.

    Article  Google Scholar 

  30. de Vries H, Elliott MN, Kanouse DE, et al. Using pooled kappa to summarize inter-rater agreement across many items. Field Methods. 2008;20:272–82.

    Article  Google Scholar 

  31. Mast MS. On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns. 2007;67(3):315–8.

    Article  PubMed  Google Scholar 

  32. DiMatteo MR, Taranta A, Friedman HS, et al. Predicting patient satisfaction from physicians’ nonverbal communication skills. Med Care. 1980;18(4):376–87.

    Article  PubMed  CAS  Google Scholar 

  33. DiMatteo MR, Hays RD, Prince LM. Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychol. 2006;5(6):581–94.

    Article  Google Scholar 

  34. Laidlaw TS, Kaufman DM, Sargeant J, et al. What makes a physician an exemplary communicator with patients? Patient Educ Couns. 2007;68:153–60.

    Article  PubMed  Google Scholar 

  35. Hall JA, Harrigan JA, Rosenthal R. Nonverbal behavior in clinical-patient interaction. Appl Prev Psychol. 1995;4:21–37.

    Article  CAS  Google Scholar 

  36. Griffith CH, Wison JF, Langer S, et al. House staff nonverbal communication skills and standardized patient satisfaction. JGIM. 2003;18:170–4.

    Article  PubMed  Google Scholar 

  37. Hall JA, Irish JT, Roter DL, et al. Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. Health Psychol. 1994;13(5):384–92.

    Article  PubMed  CAS  Google Scholar 

  38. Mast MS, Hall JA, Roter DL. Disentangling physician sex and physician communication style: their effects on patient satisfaction in a virtual medical visit. Patient Educ Couns. 2007;68(1):16–22.

    Article  Google Scholar 

  39. Bensing JM, Dronkers J. Instrumental and affective aspects of physician behavior. Med Care. 1992;30:283–98.

    Article  PubMed  CAS  Google Scholar 

  40. Evans RW, Evans RI, Sharp MJ. The physician survey on the post-concussion and whiplash syndromes. Headache. 1994;34:268–74.

    Article  PubMed  CAS  Google Scholar 

  41. Hyman DJ, Pavlik VN. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Int Med. 2000;16(15):2281.

    Article  Google Scholar 

  42. Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S. A survey of primary care physicians in eleven countries, 209: perspectives on care, costs and experiences. Health Affairs. 2009;28(6):w1171–83.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge and thank the many doctors who shared their time and talked openly with us about their experiences. We also thank the many people from the health plan that collaborated with us. In addition, we want to acknowledge RAND colleagues Beverly Weidmer and Magdalen Paskell who helped with recruiting and scheduling of these interviews as well as Dr. Stephanie Teleki for her assistance. Preparation of this manuscript was supported through a cooperative agreement from the Agency for Healthcare Research and Quality (U18 HS016980). The study design, data collection, interpretation of data, and analysis are independent of the funder and are the full responsibility of the authors. There are no conflicts of interest for the authors in preparing or writing this article.

Author contributions

Dr. Quigley was the main author of the paper and led the research with the participating health plan that included conducting the interviews, coding the transcripts, and mapping themes to the survey items. She is the guarantor of the content of the manuscript. Dr. Martino helped conduct interviews and was one of the coders of the interview transcripts. He reviewed drafts of the paper and provided edits. Julie Brown is the survey development expert for all CAHPS surveys, and reviewed drafts of the paper and provided edits.

Dr. Hays is the Principal Investigator (PI) of the CAHPS project and reviewed drafts of the paper and provided edits.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Denise D. Quigley.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 115 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quigley, D.D., Martino, S.C., Brown, J.A. et al. Evaluating the Content of the Communication Items in the CAHPS® Clinician and Group Survey and Supplemental Items with What High-Performing Physicians Say They Do. Patient 6, 169–177 (2013). https://doi.org/10.1007/s40271-013-0016-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40271-013-0016-1

Keywords

Navigation