CAHPS Research Articles

Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms

ABSTRACTObjectives: This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS.Methods: Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the ‘How Well Doctors Communicate’ composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used.Results: CSDS are associated with greater odds of having ‘poor’ perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand.Conclusion: Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients’ unique needs and communication preferences to ensure receipt of quality care.

The Dialysis Facility Compare Five-Star Rating System at 2 Years.

The 1997 Balanced Budget Act required the Centers for Medicare and Medicaid Services (CMS) to develop and implement a method to measure and report the quality of kidney dialysis services provided by Medicare ([1][1]). As a result, CMS launched the Dialysis Facility Compare (DFC) website in 2001,

Patient-Provider Communication and Health Outcomes Among Individuals with Hepato-Pancreato-Biliary Disease in the USA

BackgroundPatient-provider communication (PPC) is utilized as a value-based metric in pay-for-performance programs. We sought to evaluate the association of PPC with patient-reported health outcomes, as well as healthcare resource utilization among a nationally representative cohort of patients with hepato-pancreato-biliary (HPB) diagnoses. MethodsPatients with HPB diseases were identified from the 2008–2014 Medical Expenditure Panel Survey cohort. A weighted PPC composite score was categorized using the responses from the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey as optimal, average, or poor. Multivariate analysis was performed using logistic regression. ResultsAmong 1951 adult-patients, representing 21.7 million HPB patients, reported PPC was optimal (33.4%), average (46.3%), or poor (15.3%). Patients who were older and patients with low income were more likely to report poor PPC (both p < 0.05). Statin use, a quality of care measure, was associated with optimal PPC (OR 1.70, 95% CI 1.10–2.64; p = 0.01). In contrast, patients who reported poor PPC were more likely to have a poor physical (20.8%) or mental (8.8%) health component on their SF12 (both p < 0.05). Furthermore, patients with poor PPC were more likely to report poor mental status (OR 2.97, 95% CI 1.60–5.52), as well as higher emergency department visits (OR 1.95, 95% CI 1.25–3.05) and hospitalizations (OR 1.90, 95% CI 1.02–3.55) (both p < 0.05). Reported PPC was not associated with differences in overall healthcare expenditures or out-of-pocket expenditures. ConclusionsPPC was associated with a wide spectrum of patient-specific demographic and health utilization factors. Self-reported patient satisfaction with provider communication may be impacted by other considerations than simply the patient-provider interaction.

Ethnic differences in patients\u2019 perceptions towards isolated orthopedic injuries: a pilot study

BackgroundPatients’ perceptions of their healthcare have been reported to influence clinical outcomes following orthopedic trauma. Findings across clinical outcomes have demonstrated significant differences in perceptions towards healthcare between Hispanics and non-Hispanic whites. However, ethnic disparities in perceptions towards orthopedic injuries have not been examined in the literature.Aim of studyThe aim of this pilot study is to explore whether Hispanic patients with isolated orthopedic injuries will demonstrate different perceptions towards their injury as compared to non-Hispanic white patients. The pilot data will be used to inform a subsequent larger clinical investigation and interventional study.MethodsA total of 43 patients (31 Hispanics and 12 non-Hispanic whites) with isolated orthopedic injuries requiring surgical treatment were enrolled in this cross-sectional observational pilot study. Outcome measures included the Questionnaire of Perceived Injustice (QPI), Short-Form 36 Health Survey (SF-36v2), Pain Catastrophizing Scale, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence (CC) item set.ResultsThe CAHPS was completed by 34 patients, and the remaining scoring systems were completed by all 43 subjects enrolled in this study. Hispanic patients trended towards higher QPI scores indicating poorer outcomes than non-Hispanic whites (mean difference [MD] 5.4, 95%; confidence interval [CI] − 4.4, 15.2). The mental component summary score of the SF-36 trended lower in Hispanics as compared to non-Hispanic white (MD − 6.8, 95%; CI − 15.0, 1.4). Hispanic patients also expressed less trust in their doctor on a scale from 0 to 10 (MD − 1.0, 95%; CI − 1.9, − 0.1).ConclusionsOur study suggests ethnic differences in patients’ perceptions towards isolated orthopedic injuries. These results must be interpreted cautiously given the limited number of subjects in this pilot examination. We collected sufficient data to allow a sample size calculation for a subsequent larger clinical investigation. Future clinical investigations may determine the influence of ethnic differences in patients’ perceptions towards orthopedic injuries, identify their impact on the functional outcomes, and establish intervention strategies.

Web-Based Patient Experience Surveys to Enhance Response Rates A Prospective Study.

Patient experience is a critical component of continuous quality improvement and value-based health-care delivery. This study aimed to identify a simple, cost-effective means of administering a validated patient experience survey in ambulatory-care settings. Patients were randomly assigned to groups to complete the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) clinician and group patient satisfaction survey using a Web-based platform. The response rate was assessed for in-clinic and e-mail distribution and was compared with the historical response rates. Patients were able to change groups after randomization to assess effect on response rate and potential bias. The cost of survey administration was compared. Of 132 participants, 87 completed surveys (65.9%), with no significant differences among distribution methods. Twenty-three participants self-selected the in-clinic survey after being randomized to the e-mail cohort. Survey responses were statistically significantly different in only three of 34 questions. Web-based survey administration costs two to four times less than standard mail, phone, and mixed-modal survey administration. We recommend that ambulatory clinics use Web-based technology to administer CAHPS clinician and group surveys, using both e-mail and in-clinic distribution to enhance the response rate.

Analysis of Wait Times and Impact of Real-Time Surveys on Patient Satisfaction.

Increasing emphasis is being placed on patient satisfaction, which is linked to reimbursement rates. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a national, standardized survey used to assess patient satisfaction. Its limitations include the length of the survey, delay in administration, and generalization to all specialties. Ideal patient satisfaction surveys should collect information in a way that allows for corrective action in a timely manner. To evaluate patient dissatisfaction with wait time using a short, in-office, real-time survey. A cross-sectional study in which patients from one provider's office completed a real-time survey. These results were compared with the CAHPS survey data of the same time period. Seven hundred fifty-six patients were seen and 251 surveys were collected. The real-time survey response rate was 33% compared with 9% for the CAHPS survey. Overall, 95.74% of patients who completed the real-time survey were satisfied with their wait times and the duration of their visit, versus 84.2% from the CAHPS survey. Implementation of a short in-office survey immediately after patient care can provide better feedback that can be used to ensure that improvement measures are aimed at making significant strides in improving overall health outcomes for patients.

Evaluating the Use of a Novel Patient-Reported Outcomes Measure in Cancer Care: A Pilot Study in Patients Receiving Radiation Therapy

Patient safety is a cornerstone of high quality cancer care. However, current efforts rely on clinician-centric methods. In this IRB-approved pilot study, we evaluated the feasibility of an innovative approach to prospectively capture system safety data using patient-reported non-routine events (PNREs), defined as events that deviate from expected/optimal care. We postulated that safety-related PNREs will identify potential flaws in cancer care pathways that increase the likelihood of unplanned treatment events/errors (UTEs) and lower standardized experience measures. Eligibility included ECOG 0-2 adult patients with newly diagnosed head/neck & lung cancer scheduled to receive curative radiation (RT). PNREs, using our previously validated Patient-reported Comprehensive Open-ended Non-routine Event Survey (PCONES) tool, and patient-reported experience measures including: the EORTC-QLQ-30 (to compute a Global Health Status (GHS) on a 0-100 scale), the NCCN Distress Thermometer (DT, 0-10 scale), and 4 core ambulatory Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey questions, were collected at each on-treatment visit. Additionally, physicians completed the NCI CTCAE v4.0 toxicity score and collected UTEs from the patients’ medical records. Propensity score weighting and regression methods were used to quantify associations between PNREs and patient experience. 20/24 patients (pts) who enrolled with 2 months f/u during RT comprise our study cohort. Mean age was 64.5±2.1 year (SEM); 60% male. Overall, 80 encounters occurred, median of 4 (range: 3-5). In 39% of encounters, at least one PNRE was reported yielding 40 total PNREs from 75% of the pts. 32.5% of PNREs were safety related while the remaining were related to pts’ care experience. In encounters when pts did not report PNREs, the GHS and DT measurements were 70.8±3.0 and 2.5±0.4, respectively. In cases where pts reported at least one PNRE, GHS decreased to 63.9±4.4 (p=0.182) and distress increased to 3.7±0.6 (p=0.088). The GHS was even lower (56.4±6.9) and distress higher (4.6±0.9) in pts who experienced safety-related PNREs. Three study pts each had one UTE (15% of participants), including a hospital readmission for surgical complications. 15.4% of the adult safety-related PNREs related to these UTEs. The 5 pts who never reported a PNRE experienced no UTEs. Encounters in which PNREs were reported were associated with lower CAHPS composite scores – no PNRE: 58% top-box ratings; ≥1 PNRE: 19% top-box ratings (p<0.001). This pilot study demonstrates the feasibility of collecting PNREs to identify potential systems safety risks in a radiation oncology clinic. Future efforts will include a large phase II trial to validate these findings, and to assess the value of PNREs in improving cancer care processes and patients’ outcomes.

Reliability of Physician-Level Measures of Patient Experience in Primary Care.

Patient experience measures are widely used to compare performance at the individual physician level. To assess the impact of unmeasured patient characteristics on visit-level patient experience measures and the sample sizes required to reliably measure patient experience at the primary care physician (PCP) level. Repeated cross-sectional design. Academic family medicine practice in California. One thousand one hundred forty-one adult patients attending 1319 visits with 56 PCPs (including 45 resident and 11 faculty physicians). Post-visit patient experience surveys including patient measures used for standard adjustment as recommend by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Consortium and additional patient characteristics used for expanded adjustment (including attitudes toward healthcare, global life satisfaction, patient personality, current symptom bother, and marital status). The amount of variance in patient experience explained doubled with expanded adjustment for patient characteristics compared with standard adjustment (R2 = 20.0% vs. 9.6%, respectively). With expanded adjustment, the amount of variance attributable to the PCP dropped from 6.1% to 3.4% and the required sample size to achieve a reliability of 0.90 in the physician-level patient experience measure increased from 138 to 255 patients per physician. After ranking of the 56 PCPs by average patient experience, 8 were reclassified into or out of the top or bottom quartiles of average experience with expanded as compared to standard adjustment [14.3% (95% CI: 7.0-25.2%)]. Widely used methods for measuring PCP-level patient experience may not account sufficiently for influential patient characteristics. If methods were adapted to account for these characteristics, patient sample sizes for reliable between-physician comparisons may be too large for most practices to obtain.

To what extent does patient experience account for variation in patient satisfaction with a healthcare system?

Background: Patient experience and patient satisfaction, the two recognized indicators for assessing the quality of healthcare, are related, but distinct concepts. While there is existing evidence concerning a statistically significant association between these two concepts, research on the extent to which patient experience accounts for variation in patients’ overall satisfaction with health services has produced contradictory results. Objectives: The primary aim of this paper was to determine the extent to which satisfaction with a healthcare system is explained by patient experience. A secondary objective was to identify the aspects of patient experience that relate most strongly to satisfaction with health services.Methods: The study was a secondary analysis of quantitative data from the 2006 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Multivariate regression analysis was used to assess the association between global satisfaction and CAHPS domains of patient-reported experience with healthcare. Pearson product moment correlation coefficients were computed to ascertain the aspects of patients’ experiences that have strong association with their overall satisfaction. Findings: Much (67.4%) of the variation in overall patient satisfaction was accounted for by patient experience. Factors related to patient-professional relationship related strongly with patients’ overall satisfaction with health servicesConclusion: Patient experience of care is a major determinant of patients’ overall satisfaction with a healthcare system and the two concepts are not marginally related.

Implementation of Practice Transformation: Patient Experience According to Practice Leaders.

Examine practice leaders' perceptions and experiences of how patient-centered medical home (PCMH) transformation improves patient experience. Thirty-six interviews with lead physicians (n = 13), site clinic administrators (n = 13), and nurse supervisors (n = 10). Semi-structured interviews at 14 primary care practices within a large urban Federally Qualified Health Center (FQHC) delivery system to identify critical patient experience domains and mechanisms of change. Identified patient experience domains were compared with Consumer Assessment of Healthcare Providers and Systems (CAHPS) items. We identified 28 patient experience domains improved by PCMH transformation, of which 22 are measured by CAHPS, and identified 24 mechanisms of change commonly reported by practice leaders during PCMH transformation. PCMH practice transformation can improve patient experience. Most patient experience domains reported as improved during PCMH efforts are measured by CAHPS items. Practices would benefit from collecting specific information on staff behaviors related to teamwork, team-based communication, scheduling, emergency and inpatient follow-up, and referrals. All 3 types of practice leaders reported 4 main mechanisms of PCMH change that improved patient experience. Our findings provide guidance for practice leaders on which strategies of PCMH practice transformation lead to specific improvements in patient experience measures. Further research is needed on the relationship between PCMH changes and changes in CAHPS patient experience scores.

Black And Hispanic Patients Receive Hospice Care Similar To That Of White Patients When In The Same Hospices.

Little is known about racial and ethnic variation in the quality of hospice care. We used data on 292,516 respondents for 2015-16 from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to assess how the patient and family experience of hospice care differed among black, Hispanic, and white patients. We found that, on average, black and Hispanic patients received care from poorer quality hospices. Within a given hospice, we found that friends and relatives who served as caregivers of black and Hispanic patients reported significantly better hospice care experiences than their peers serving as caregivers of white patients on five of seven outcomes. However, caregivers of black and Hispanic patients reported receiving their desired level of emotional and religious support less often than caregivers of white patients did. As more black and Hispanic patients enroll in hospice care, it is critical to ensure that they have access to high-quality, culturally competent hospice services.

Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults.

This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.

Satisfaction among lung cancer (LCa) patients (pts) in multidisciplinary (MDC) vs. serial care (SC) settings.

e18254 Background: Coordinated MDC, in which all key specialists concurrently provide early input, develop and execute a consensus plan of care in collaboration with pts and their caregivers, may improve satisfaction with care. We rigorously evaluated this premise. Methods: Prospective clinical cohort study comparing newly-diagnosed LCa pts receiving MDC (n=156) or SC (n=307) in the same healthcare system. Pts were enrolled before treatment onset. At baseline (study entry) and 3 months later, pts and caregivers completed treatment-related measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, including perceptions of quality of care, satisfaction with care, and extent of involvement in decision making. Satisfaction indices at 3 months will be compared in multiple linear regression models, adjusting for baseline scores and demographic and treatment-related characteristics. Results: Pt characteristics were similar, except for age and stage (Table). At baseline, MDC pts rated their care more positively than SC pts, but satisfaction with provider communication was similar. Three month data are currently being analyzed. Conclusions: MDC provided greater pt satisfaction in the diagnostic phase of LCa care. Further prospective analyses will test the hypothesis that MDC pts experience greater satisfaction with quality of care and provider communication compared to SC pts. Clinical trial information: NCT02123797. [Table: see text]

Patient experiences of cancer care: scoping review, future directions, and introduction of a new data resource: Surveillance Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS)

The shift towards providing high value cancer care has placed increasing importance on patient experiences. This scoping review summarizes patient experience literature, highlights research gaps, and provides future research directions. We then introduce a new resource that links the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program with the Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and longitudinal medical claims data. We conducted a scoping review to identify relevant research within the Medicare CAHPS domain that examine factors associated with patient-reported experiences with their cancer care. Gaps indicate a need for population-based research to explore relationships between cancer patient experiences, healthcare utilization, and subsequent patient outcomes. SEER-CAHPS, a publicly accessible data resource, may assist in addressing these gaps by linking cancer registry (SEER), survey data reported by Medicare beneficiaries (CAHPS), and Medicare claims, providing unique insight into quality of care. Linked data include 231,089 surveys from patients with a cancer diagnosis, and 4,236,529 surveys from patients without a cancer diagnosis. Results indicate substantial gaps in our knowledge of patient experiences and the need for additional resources. SEER-CAHPS links direct patient feedback with cancer registry and Medicare claims, making it an important source of information on experiences and healthcare utilization. Increasing recognition of the importance of patient-centeredness points to the need for population-based studies. Findings from SEER-CAHPS will inform initiatives to improve care delivery.

Measuring experiences of patients with cancer with care: The SEER-CAHPS linked data resource.

238 Background: Care experience ratings are recognized as measures of quality. We introduce a new resource, SEER-CAHPS, linking cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: The SEER-CAHPS data resource includes registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. SEER-CAHPS includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plan and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. The data also contain optional survey weights to account for the Medicare CAHPS sampling design. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The database also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; experiences of dually eligible (Medicare-Medicaid) cancer patients; and the associations of guideline-concordant follow-up care with patient experiences among people with colorectal cancer. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS provides population-based, cancer-specific data on patient experiences and associations with both health outcomes and healthcare utilization.

Abstract 189: Income Level Disparities in Consumer Reported Domains of Healthcare Experience Among Those With Established Atherosclerotic Cardiovascular Disease in United States: Insights From Medical Expenditure Panel Survey 2010-2013

Background: While it is well established that significant health outcome disparities exist across patients of varying socio-economic status (SES) with established atherosclerotic cardiovascular disease (ASCVD), disparities in patients’ healthcare experiences are not well investigated. We explore income level differences in four central tenets of patient-reported healthcare experience (access to care, provider communication, shared decision making and provider satisfaction) as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, in a nationally representative adult US population with established ASCVD. Methods: The study population consisted of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We assessed the responses for each item as: a) difficult access to care (always/almost difficult), b) ineffective communication and shared decision making (never/sometimes), and c) poor provider satisfaction (lowest quartile on a scale of 0-10). We examined the relationship between scores in the lowest quartile of each domain composite scores, derived using the weighted average response from each items scores, with patients’ SES, using the high-income group as reference. Results: Lower SES was consistently associated with greater perceived difficulties in access, poor provider-patient communication, less shared decision making, as well as lower provider satisfaction (Table). Participants classified as poor vs. high income were 47% (95% CI 1.17-1.83) more likely to report difficulty accessing care, 39% (95% CI 1.09-1.78) and 26% (95% CI 0.99-1.60) reported a higher likelihood of experiencing poor communication and shared decision making respectively, as well as a 66% (95% CI 1.31-2.11) higher likelihood of reporting lower provider satisfaction. Conclusion: Among patients with established ASCVD, significant SES disparities exist in all domains of patient reported healthcare experience quality of care metrics. Targeted policies focusing on improving communication, engagement and satisfaction are needed to enhance patient healthcare experience among high-risk vulnerable populations.

CAHPS and Comments: How Closed-Ended Survey Questions and Narrative Accounts Interact in the Assessment of Patient Experience.

Objectives:To investigate whether content from patient narratives explains variation in patients’ primary care provider (PCP) ratings beyond information from the closed-ended questions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores.Methods:Members of a standing Internet panel (N = 332) were randomly assigned to complete a CAHPS survey that was either preceded or followed by a set of open-ended questions about how well their PCP meets their expectations and how they relate to their PCP.Results:Narrative content from healthier patients explained only an additional 2% beyond the variation in provider ratings explained by CAHPS composite measures. Among sicker patients, narrative content explained an additional 10% of the variation. The relative placement of closed- and open-ended questions had little impact on narratives or CAHPS scores.Conclusion:Incorporating a protocol for eliciting narratives into a patient experience survey results in minimal distortion of patient feedback. Narratives from sicker patients help explain variation in provider ratings.

Colorectal cancer survivors’ surveillance patterns and experiences of care: A SEER-CAHPS study.

229 Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, generally treated with surgical resection, followed by complex surveillance for recurrence. We examined associations between experiences of care and adherence to surveillance Medicare fee-for-service beneficiaries with a history of CRC. Methods: Using linked data from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) cancer registry program, Medicare claims and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience surveys (SEER-CAHPS), we identified survivors ages 65+, diagnosed with local/regional first primary colorectal cancer 1999-2009 who underwent surgical resection and completed CAHPS survey within 36 months of diagnosis. Adherence to guidelines for a three-year observation period was defined as receiving a colonoscopy; at least 2 carcinoembryonic antigen (CEA) tests; and more than 2 office visits and 1 computer tomography (CT) imaging test each year. We dichotomized CAHPS ratings into 9 or 10 out of 10 versus 0-9 for analysis (higher ratings mean better quality). Results: Most of the 314 participants reported ratings of 9 or 10 for overall care (55%), personal doctor (59%), and health plan (60%). Slightly less than half (47%) gave their specialist doctor ratings of 9 or 10. Adherence to surveillance was 76% for office visits, 36.9% for CEA testing, 48.1% for colonoscopy, and 10.3% for CT Imaging. Sixty-two percent of the sample were categorized as adherent (receiving ≥ 2 surveillance guidelines). In multivariable models, adherence to office visits was positively associated with ratings of personal doctor (OR = 2.0; 95% CI = 1.1, 3.5) and specialist doctor (OR = 2.7; 95% CI = 1.4, 4.9), and overall adherence was associated with ratings of personal doctor (OR = 2.1; 95% CI = 1.2, 3.6). Conclusions: Findings point to the important role of patient-provider relationships in adherence to CRC post-resection surveillance guidelines. As adherence to surveillance may increase survival among CRC survivors, further investigation is needed to identify specific components of this relationship, as well as other potential modifiable drivers of surveillance guidelines.

Role of Google Glass in improving patient satisfaction for otolaryngology residents: a pilot study.

To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication-related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Prospective randomised trial. Tertiary care hospital. To evaluate the effect on patient satisfaction, five residents were recorded using the Google Glass in an outpatient clinic setting by 50 randomised patients. Modified surveys based on the CG-CAHPS survey were completed by patients at the conclusion of each clinic encounter. The recorded videos were evaluated by two independent faculties. Summarised data and video were distributed to each resident for review as the intervention. The residents were recorded again by 45 additional patients with evaluation by patients and faculties. After intervention, the scores from faculty surveys regarding patient satisfaction including the subject of better explanations (P > 0.001), listening carefully (P > 0.001), addressing patient questions (P > 0.001), displaying respect (P > 0.001) and spending adequate time (P = 0.0005) all significantly improved, as well as overall performance (P = 0.014). The scores from patient surveys did significantly improve. This study demonstrates the improvements in patient satisfaction and patient-physician communication can be achieved with the use of Google Glass as a first-person recording device in the outpatient otolaryngology clinic setting.

Understanding health talk in an urban Aboriginal and Torres Strait Islander primary healthcare service: a cross-sectional study.

Health literacy is an important determinant of health status. This cross-sectional study aimed to describe the prevalence of adequate health literacy among Aboriginal and Torres Strait Islander patients or their carers including parents of sick children attending an urban primary healthcare clinic in Australia, and their experiences of communication with General Practitioners (GPs). A questionnaire, including questions from the Brief Health Literacy Screen (BHLS) and questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS): Communication with Provider, was administered to 427 participants. Descriptive statistics, Pearson's Chi-Square test and logistic regression analysis were used to describe the prevalence and risk factors associated with health literacy and any associations between the CAHPS questions and health literacy. In total, 72% of participants had adequate health literacy. An age of ≥50 years was independently associated with inadequate health literacy, and completion of secondary or post-secondary schooling was protective. Communication questions that identified areas for improvement included less use of incomprehensible medical words and more frequent use of visual aids. The study provides useful information on health literacy among Aboriginal and Torres Strait Islander patients, or their carers, and their experiences of communication with GPs. Further population-based research is required to investigate the effect of health literacy on health outcomes of Aboriginal and Torres Strait Islander patients.