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Patient Satisfaction/Patient Experience, Patient-Reported Outcomes, and Healthcare Quality: Are We Focusing on the Wrong Metrics?

Haley, Marsha (2022) Patient Satisfaction/Patient Experience, Patient-Reported Outcomes, and Healthcare Quality: Are We Focusing on the Wrong Metrics? Master Essay, University of Pittsburgh.

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Background: To meet the Institute of Medicine goal of patient-centered healthcare quality, Patient Satisfaction/Patient Experience (PS/PE) has evolved to become 25 percent of the U.S. government’s Medicare and Medicaid Value-Based Purchasing (VBP) Program. PS/PE is most commonly measured by CAHPS® and Press Ganey® (PG) surveys. Patient-reported Outcomes (PROs) are also measured as part of the VBP, but are not used for reimbursement.

Materials and Methods: We performed a MEDLINE literature search to evaluate whether high-level evidence (randomized controlled trials, systematic reviews, or meta-analyses) exist to show that CAHPS®, PG®, and PROMIS® survey scores correspond with improved quality of healthcare.

Results: The number of publications on PS/PE and PRO has increased significantly since the initiation of patient surveys. One systematic review found that CAHPS® scores were inconsistently associated with patient-reported quality. Zero studies were found to show that PG® scores were associated with improved quality. Five studies showed that PROMIS® had convergent validity with legacy measures of PRO. Further review of the literature showed concerns inherent in the way CAHPS® and PG® are used which may adversely affect healthcare quality.

Conclusion: PS/PE is weighted highly for reimbursement. The most-utilized PS/PE surveys have psychometric and methodologic flaws and, using the above literature search method, we found very little high-level data showing that CAHPS® and PG® scores correlate with improved healthcare quality as defined by the IOM. PROMIS® is a reliable, valid, and precise measure of patient-reported health status. CMS should consider a policy change to decrease the weight of PS/PE in the VBP program. At the same time, CMS should consider incorporating PRO data into reimbursement.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Haley, Marshamlh179@pitt.edumlh179
ContributionContributors NameEmailPitt UsernameORCID
Thesis advisorRoberts, Markmroberts@pitt.edumrobertsUNSPECIFIED
Committee MemberJanel, Hanmerhanmerjz@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberTriola, Amyuhlerae@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 17 May 2022
Date Type: Completion
Submission Date: 19 April 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 28
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: patient satisfaction; patient experience; patient reported outcomes; healthcare quality
Date Deposited: 17 May 2022 15:43
Last Modified: 17 May 2022 15:43


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