Development of the Patient-Centered Medical Home Item Set

The development of the Patient-Centered Medical Home Item Set began in the fall of 2009.

Literature review. The CAHPS team conducted a literature review to ensure that the items would reflect appropriate content and the best research in this area.

Technical Expert Panel input. The CAHPS team assembled a panel of PCMH experts representing various stakeholders, including providers, health plans, payers, professional organizations, policymakers, and regional collaboratives, to provide input on the development and use of a CAHPS survey to assess patient experience with the medical home. Panel members were interviewed in late 2009 and early 2010; the panel met in person in April 2010 and by phone in July 2011.

Stakeholder input. Stakeholder input is critical to the CAHPS survey development process. The CAHPS team benefited from extensive feedback that the National Committee for Quality Assurance (NCQA) gathered from stakeholders on the development of a patient experience survey for its PCMH program.

Focus group input. In summer 2010, adult patients and parents of children receiving care in medical home practices provided input to:

• Confirm the domains of interest identified by the Technical Expert Panel and other stakeholders;
• Identify additional domains, if any; and
• Convey how they describe the care they receive in their medical homes.

Cognitive testing (English and Spanish). In August 2010, the CAHPS team conducted cognitive testing of draft questionnaires that incorporated PCMH items into the CG-CAHPS 12-Month Survey 2.0. The testing was done with both adults and children in English and Spanish. A second round of cognitive testing was completed in the spring of 2011. The team revised the draft questionnaires based on the findings from the cognitive interviews.

Field testing. NCQA field tested the instrument in the winter of 2010-2011. The CAHPS team also conducted subsequent rounds of testing to support the adoption and implementation of these items by a range of users.

Psychometric analysis. In the spring of 2011, the CAHPS team analyzed the data collected during field testing to determine the psychometric properties of the survey items. This analysis informed the final 2.0 version of the PCMH Item Set.

Public release. In October 2011, AHRQ released a final preassembled survey that incorporates the PCMH items into the CG-CAHPS 12-Month Survey 2.0. The survey is also part of the NCQA’s specifications for its PCMH recognition program.

Updating of the PCMH Item Set. In 2015, the CAHPS team proposed changes to the PCMH Item Set in response to feedback from NCQA’s stakeholders and survey users as well as analytical findings indicating that the response rates for some items have not been sufficient to achieve the desired level of reliability. In January 2015, AHRQ published a description of these changes in a Federal Register Notice for public comment.

• For a description of the proposed changes, read: Proposed Changes to the CAHPS Clinician & Group Survey Jan. 2015 (PDF) [1.23 MB])
• For a summary of the responses to the proposed changes, read: Summary and Next Steps in Response to Federal Register Notice (FR Doc 2015-00767) (PDF) [344.77 KB])

The feedback from this process influenced whether items would be included in the core CG-CAHPS Survey 3.0, the PCMH Item Set 3.0, or the broader set of supplemental items.

Version 3.0 of the PCMH Item Set was released in July 2015.