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Using the Home Health Care CAHPS (HHCAHPS) Survey With Other Home Health Agency Surveys

The following is a clarification of the protocol to be used by home health agencies (HHAs) that choose to administer other patient surveys (i.e., in addition to HHCAHPS). These guidelines supersede the protocol related to administering other surveys described in Chapter IV of the Home Health Care CAHPS Survey Protocols and Guidelines Manual, Version 2.0. The Centers for Medicare & Medicaid Services (CMS) and the HHCAHPS Coordination Team understand that some home health agencies may wish to conduct other patient surveys to support internal quality improvement activities. We define a "survey" as follows:


A formal, HHCAHPS-like, patient experience/satisfaction survey. A formal survey, regardless of the mode employed, is one in which the primary goal is to ask standardized questions of a sample of the HHA's patient population.

Contacting patients to assess their care at any time or calling a patient to check on services received are both considered to be routine patient contacts, not surveys. To ensure that valid data are collected on HHCAHPS and that the data collected represent patients' perspectives of the home health care they receive, please use the following guidelines for administering other surveys in conjunction with HHCAHPS. 1. For each sample month, the Home Health Care CAHPS Survey sample must be selected prior to selecting the samples for any other home health agency survey. 2. In other surveys that a home health agency conducts, the agency can include questions that ask for more in-depth information about HHCAHPS issues, but should not repeat the HHCAHPS questions or include questions that are very similar. Home health agencies cannot ask their patients why they gave a certain response or rating to any of the HHCAHPS Survey questions. These guidelines should be implemented as follows:

Select the Sample for the HHCAHPS Survey First


Each agency participating in HHCAHPS must provide a monthly patient information file to its HHCAHPS vendor prior to selecting the sample for any other survey the agency conducts. The HHCAHPS vendor will select the sample for HHCAHPS for the sample month. Patients who were not randomly selected into the Home Health Care CAHPS Survey sample for the sample month may be included in a sample for a separate survey in that month. This secondary survey sample must be selected after the HHCAHPS survey sample has been drawn. Patients for agency secondary surveys may be chosen from:


­ Those patients who are not part of the survey sample selected by the vendor

from the monthly patient information file for HHCAHPS; and

­ All non-Medicare and non-Medicaid patients who are not eligible for HHCAHPS.


The following is an example of the above guideline. Note that the names of the HHA and the approved survey vendor in this scenario are fictional. Example Assume that the HHCAHPS sample month was November 2009. The Exceptional Home Care Agency (EHCA) provided health care to a total of 200 patients during that month. Of those 200 patients, 3 had received hospice care, 2 were under age 18, and 2 were deceased. When preparing the monthly patient information file for that sample month, EHCA's data manager included the required patient information on all of the patients it served in November except for the three who had received hospice care, the two who were deceased, and the two under age 18. This agency therefore submitted a patient information file for the November sample month containing patient information for 193 patients to its HHCAHPS survey vendor, OnTime Survey Research, Inc. Prior to beginning its participation in HHCAHPS, EHCA had provided a file to its survey vendor containing patient information for patients served during a 3-month period. OnTime Survey Research used that information to determine a sample ratio to use when selecting the monthly HHCAHPS sample for EHCA. Based on the number of patients who met survey eligibility criteria during those 3 months, OnTime Survey Research determined that a sample ratio of 30% would yield the targeted minimum number of completed HHCAHPS surveys for a 12-month period. After processing the November patient information file received from EHCA, OnTime Survey Research constructed the HHCAHPS sample frame for the November sample month. Of the 193 patients included on the November patient information file, OnTime Survey Research excluded:

· · ·

10 patients because they were not Medicare and/or Medicaid patients; 15 patients because they had not receive at least 2 skilled care visits during the lookback period; and 3 patients because they had received care for routine maternity care only.

Therefore, 165 patients were included on the sample frame for the November sample month. Using a sampling ratio of 30%, OnTime Survey Research then selected the HHCAHPS sample for the November sample month. Of the 165 patients included on the sample frame, 50 patients were included in the November HHCAHPS Survey sample. EHCA wanted to conduct another survey of its patients in December 2009. Based on the HHCAHPS guidelines and protocols, all of the patients who received care from EHCA in November 2009 were eligible to be included in the other survey except the 50 patients who were sampled for HHCAHPS. This includes the patients who were eligible for the survey but were not included in the November HHCAHPS sample and patients deemed ineligible for the HHCAHPS Survey--that is, those who were not Medicare and/or Medicaid patients, those receiving maternity care only, those under age 18, and those who did not have two skilled visits. Because patients included in the HHCAHPS sample can not be sampled more than once within 5 months after they are sampled for HHCAHPS, the 50 patients included in EHCA's November HHCAHPS sample would be eligible for inclusion in any other survey that EHCA conducts from January through May 2010.


Conducting Other Surveys With Questions Similar to HHCAHPS Questions


Other surveys administered by the home health agency should not include questions that are the same as or similar to those included in the Home Health Care CAHPS Survey. The following are some examples of the types of questions that should not be included in any other surveys the agency conducts.

­ "Did the home health agency office answer all of your questions?" (This question

is similar to Q22 in the HHCAHPS Survey Questionnaire.)

­ "On a scale of 0 to 10, how would you rate the home health care you received?"

(This question is the same as Q20 in the HHCAHPS Survey Questionnaire.)

­ "Would you recommend this agency to your family or friends?" and "Would you

recommend our services or call us in the future?" (These questions are similar to Q25 in the HHCAHPS Survey Questionnaire.) Q19 in the HHCAHPS Survey Questionnaire.)

­ "Was our staff friendly, professional, and courteous?" (This question is similar to



Using the Home Health Care CAHPS (HHCAHPS) Survey With Other Home Health Agency Surveys

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