Advancing the Impact of Consumer Experience of Care Measurement: What’s Next?

Editor’s Note: This AHRQ Views blog post is authored by members of the Agency’s National Advisory Council. The Advisory Council provides advice to AHRQ's director on Agency activities and priorities. This blog does not necessarily represent the views of AHRQ.

As healthcare providers, we want our patients to enjoy optimal outcomes. If they’re sick, we want them to heal. If they’re well, we want them to remain so. We want them to lead the healthiest lives possible, consistent with their individual goals, needs, and values. And ideally, we’d like them to be pleased with the care we provide for them. We’d like them to be happy with their experience with the healthcare system, so that they’ll come back when they need care and encourage others to do so as well.

For decades, we’ve acknowledged that quality healthcare should be patient-centered, and we have used survey tools to invite patients to share their experiences. While progress has been made and survey tools have evolved over time, many healthcare professionals feel that we have more to learn from our patients.

Given how rapidly delivery platforms are changing and how many opportunities patients have to contribute to the design and evaluation of care programs, AHRQ’s National Advisory Council (NAC) asked experts to brief us about the current state of the science of consumer experience measurement with an eye toward what’s next. Here are some key takeaways from our discussion at that July meeting:

1. Care is longitudinal and experience measurement should evolve to capture that. Healthcare often isn’t linear. It is provided in multiple episodes, often in multiple settings and by multiple clinicians. Too often we measure patient experience for a single transaction, rather than an episode of care or longitudinally.
2. We need to dig in on safety. Feedback is essential about what patients did or did not experience related to delays or gaps in care, particularly during transitions of care. Experience-of-care measurement surveys and comments do address this but can do more to identify opportunities to prevent patient harm. 
3. Care has gone digital. Think about all the platforms that patients use to interact with providers—like patient portals, scheduling assistants, and mobile apps. Patient- experience measures to assess these innovations would be helpful to ensure the innovations are having their intended impact.
4. Equity matters. Equity is among the six domains of quality. This isn’t new. But it’s being emphasized now, and appropriately so. Can we get more information from patients about their experience with bias? If patients perceive that they were treated differently than other patients for any number of reasons—such as race, language, gender, age, ability—that needs to be addressed. But we can’t address bias unless we know about it, and building on current assessments of cultural competency would be helpful. Ensuring all voices are heard and all equity-related issues are aired is important to achieving equity.
5. Patient-reported outcomes data should be collected. If we’re going to embrace the patient experience holistically, let’s make sure we collect standardized information on health status directly from the patient. We can provide what we consider to be high-quality care, but if it doesn’t address a patient’s functional status or improve their quality of life, the desired outcome hasn’t been achieved. AHRQ has already addressed adding patient-reported outcomes to the electronic health record, and the field is eager to incorporate these outcomes into experience-of-care measurement.
6. Let’s respect measurement burden for all, both patients and providers. Healthcare teams are already overworked. When adding new questions to surveys, care should be taken to solicit information that is actionable and not redundant. Importantly, patients are being asked opinions from so many service organizations that we need to be sensitive to their burden as well.  This is an area in which the promise of artificial intelligence and large-language models can be employed to help integrate survey data collection and interpretation.

At our July meeting, NAC members discussed AHRQ’s seminal work in this area. AHRQ’s CAHPS® Program is an initiative created to standardize how healthcare providers measure patients’ perceptions of their experience and provide tools to improve patient experience. When it debuted 28 years ago, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys shone a light on patient-centeredness. CAHPS surveys quickly became the gold standard for understanding patients’ care experiences across institutions and over time.

AHRQ is justifiably proud of its CAHPS Program and products. The CAHPS Health Plan Survey  was the first nationally available survey that was statistically valid and reliable. It was tested extensively and it measured what patients said was important to them. It moved healthcare forward in important ways and firmly stamped an imprint of patient-centeredness on our field.

As we ask about measurements of the consumer experience, we are mindful of the contributions that AHRQ’s CAHPS Program has provided. We are in a profoundly better place in understanding patients’ perceptions than we were just a few years ago.

We can build on the strong foundation the CAHPS Program has established and learn more from our patients. In fact, a commitment to quality and safety requires us to learn more about our patients’ perspectives on the care they experience and the outcomes they achieve. We are optimistic that patients and providers, working together, can continue to find enhanced, efficient, and innovative ways to collect and interpret data to ensure that the patient remains at the center of care.

Komal Bajaj is Chief Quality Officer of NYC Health + Hospitals/Jacobi/NCB and Professor, Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine. Elizabeth Mort is a primary care physician and the former Senior Vice President of Quality and Safety and Chief Quality Officer at Massachusetts General Hospital and the Massachusetts General Physicians Organization.

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