Development of the CAHPS Surgical Care Survey
The development of the Surgical Care Survey was sponsored by the American College of Surgeons (ACS) and the Surgical Quality Alliance (SQA), which was created by ACS in 2005 to coordinate and unify over twenty surgical and anesthesia specialty societies. Developing a standardized survey to assess patients' experiences with surgical care was important to the SQA members, which have focused on quality measurement as a major goal.
The development work on this survey was done by the American Institutes for Research (AIR) and Westat. AIR and Westat pursued the development of the instrument with the same emphasis on standardization and scientific rigor that characterize all CAHPS products and surveys.
Review a presentation about the development process: Surgical Patient Experience of Care Survey Design Project (PDF, 216 KB)
The Surgical Care Survey went through the following development process:
Literature review: AIR conducted a comprehensive review of literature on the topic of patients' experiences with surgical care. Based on this review, the team identified the following dimensions of surgical care quality:
- Information/education
- Interpersonal manner
- Pain
- Emotional support
- Accessibility/convenience
- Technical quality of care
- Efficacy/outcomes of care
- Availability
- Environment
- Customization/personalized care
- Patient involvement in care
- Continuity of care
- Overall satisfaction
- Finances
Using these dimensions, the team began work on developing specific domains for survey questions.
Meetings with stakeholders and beneficiaries. ACS held meetings with surgical care experts and stakeholders, plus six focus groups with surgical patients to better understand their needs and interests. These meetings provided the team with valuable feedback on potential survey topics and domains, as well as strategies for survey administration.
Cognitive testing. Two rounds of cognitive testing were conducted in English and Spanish. The survey developers revised the instrument according to findings from the interviews, resulting in the 44-item questionnaire used for field testing.
Field testing. In the summer of 2008, ACS went into the field to test the draft instrument with patients who had a non-emergency 90-day global surgical procedure in the last 3 to 6 months. Based on AIR's comprehensive psychometric analyses of the field test data, the survey team made revisions to the questionnaire that was submitted to the CAHPS Consortium for review.
Review by the CAHPS Consortium. In 2009, ACS submitted an application to the CAHPS Consortium requesting official adoption of the Surgical Care Survey as a CAHPS instrument. In response to feedback from the Consortium, ACS and AIR made some revisions to the questionnaire; they also did additional testing and analyses that resulted in changes to the reporting measures. The survey was approved as a CAHPS product in early 2010.
Public release. The Agency for Healthcare Research and Quality (AHRQ) released a final version of the survey in the spring of 2010.
2.0 version. AHRQ released an updated survey in December 2011. The 2.0 version reflects changes made to the CAHPS Clinician & Group Survey which was updated in October 2011. Because the changes that led to the 2.0 designation do not represent a significant digression from the 1.0 version of this survey, the shift from 1.0 to 2.0 did not affect the ability of survey users to assess trends in performance. Changes include the following:
- Rewording of the shared decisionmaking items
- Minor rewording of a few items to improve consistency within and across CAHPS surveys
- The addition of a mental health status item following the overall health status item
