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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



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.


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.


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.

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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.

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Corresponding author

Correspondence to Denise D. Quigley.

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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).

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  • Health Plan
  • Nonverbal Behavior
  • Nonverbal Communication
  • Communication Behavior
  • Patient Communication