Development and evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey for in-center hemodialysis patients

Am J Kidney Dis. 2014 Nov;64(5):753-60. doi: 10.1053/j.ajkd.2014.04.021. Epub 2014 Jul 3.


Background: The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey.

Study design: We conducted formative research to generate survey questions and performed statistical analyses to evaluate the survey's measurement properties.

Setting & participants: Formative research included focus groups, cognitive interviews, and field testing the survey with dialysis patients.

Measurements & outcomes: We assessed internal consistency reliability (Cronbach alpha) and center-level reliability for 3 multi-item scales. We evaluated construct validity using correlations of the scales with global ratings of the kidney doctor, staff, and dialysis center.

Results: Response rate was 46% (1,454 completed surveys). Analyses support 3 multi-item scales: Nephrologists' Communication and Caring (7 items, alpha=0.89), Quality of Dialysis Center Care and Operations (22 items, alpha=0.93), and Providing Information to Patients (11 items, alpha=0.75). The communication scale was correlated the most strongly with the global rating of the "kidney doctor" (r=0.78). The Dialysis Center Care and Operations scale was correlated most strongly with global ratings of staff (r=0.75) and the center (r=0.69). Providing Information to Patients was correlated most strongly with the global rating of the staff (r=0.41).

Limitations: A relatively small number of patients completed the survey in Spanish.

Conclusions: This study provides support for the reliability and validity of the CAHPS In-Center Hemodialysis Survey for assessing patient experiences of care at dialysis facilities. The survey can be used to compare care provided at different facilities.

Keywords: CAHPS In-Center Hemodialysis (ICH) Survey; end-stage renal disease (ESRD); hemodialysis; patient experiences of care; patient satisfaction; patient-centered care; quality of care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Community Participation* / methods
  • Delivery of Health Care / methods
  • Delivery of Health Care / standards*
  • Female
  • Health Care Surveys / methods
  • Health Care Surveys / standards*
  • Health Personnel / standards*
  • Hemodialysis Units, Hospital / standards*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Young Adult