The Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children's Hospital developed the Child HCAHPS survey in collaboration with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Consortium. Child HCAHPS builds on the Adult HCAHPS survey, which is used throughout the country for national reporting and benchmarking and is considered by most to be the gold standard in the field. In accordance with all other CAHPS surveys, the Child HCAHPS survey underwent a rigorous development process that includes:
Literature and Measures Review
We conducted an extensive literature and measures review of more than 1,300 peer-reviewed abstracts, research articles, and existing resources to ensure that the survey reflected the most up-to-date research in the inpatient experience of care field. These activities led to the identification of potential key domains besides those not already covered by HCAHPS.
We interviewed experts in the fields of quality measurement, pediatric care, and patient experience, including providers, payers, and professional organizations, to provide input on the development and use of Child HCAHPS to assess pediatric inpatient experience. These expert interviews provided technical and clinically-relevant advice on quality measurement, quality improvement, health disparities, and information technology.
We gathered ample feedback from provider, payer, and consumer stakeholders vested in child and family health care quality on the development of Child HCAHPS. In particular, we had convened a National Stakeholder Panel (NSP) to advise on the validity, feasibility, and usefulness of Child HCAHPS to support public reporting and quality improvement.
During November-December 2011, we conducted focus groups in Boston, Los Angeles, and St. Louis. Two groups were conducted with recently hospitalized adolescents, and 6 groups were conducted with parents of recently hospitalized children. These focus groups, which were led in both English and Spanish, provided input to confirm domains of interest identified by the literature review, experts, and other stakeholders. They also helped identify additional domains for potential inclusion.
Federal Register Notice (FRN) Input
On behalf of CEPQM, AHRQ requested input from public input through a Federal Register Notice (FRN) in January 2012. The aim of this FRN was to solicit candidate measures, including existing instruments, or relevant key concepts measuring aspects of families' experience with the quality of inpatient pediatric care.
We began cognitive testing of a draft version of Child HCAHPS in Spring 2012 and completed 94 full and 25 partial cognitive interviews throughout the development process. Cognitive testing of the English language occurred in Boston, Los Angeles, and St. Louis. Cognitive testing of the Spanish language version took place in Los Angeles and Miami. This testing examined whether the survey items were understandable and how to improve the draft instrument.
After revising some survey items based on input from cognitive interviews, we conducted a pilot field test with parents of recently hospitalized children in 8 hospitals during Summer 2012. We also conducted behavioral coding on 60 telephone surveys. Based on the analyses of the pilot test and behavioral coding, the survey was revised before the national field test. We conducted a national field test of Child HCAHPS in hospitals that serve children that started in Fall 2012, with 69 hospitals throughout the country. HCAHPS-approved vendors administered the survey by mail or telephone to families whose children had a recent inpatient stay at these hospitals.
Analysis of Field Test
We analyzed the data collected during field testing to refine the survey instrument, developed a case-mix adjustment model, and finalized the Child HCAHPS measure specifications. The final version of the 62-item Child HCAHPS instrument has 18 composite and single-item measures categorized into 5 overarching groups.
End User Cognitive Testing
After analyzing the national field test and proposing draft composite measures, we conducted an additional 23 cognitive interviews with parents to evaluate the understandability and validity of measure concepts and of measure labels used to describe each measure. End user testing occurred in 2 rounds in Atlanta and Washington, DC. Based on findings from this testing, we categorized the 18 measures into 5 groups to facilitate consumer use of the results.