Abstract: TH-PO817

CAHPS Domains as Predictors of Dialysis Facility Star Ratings and QIP

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Kshirsagar, Abhijit V., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Alishahitabriz, Amir, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Bang, Heejung, UC-Davis, Davis, California, United States
  • Lee, Shoou-Yih Daniel, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background

Recent national initiatives have focused on differing aspects of dialysis care quality in the United States. The Dialysis Facilities Compare (DFC) star rating & the Quality Incentive Program (QIP) generate distinct scores from clinical measures to quantify care quality. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey evaluates the patient experience to assess the perceived quality of care in separate domains related to dialysis facility & staff, nephrologists, and peer-to-peer counseling. Knowing how the patient experience relates to star ratings & QIP may help providers develop strategies to improve dialysis care delivery.

Methods

We linked the star ratings and QIP scores with CAHPS survey results for each dialysis clinic by its unique identifier (available at the DFC website) for calendar year 2016. With the CAHPS domains as independent variables, we calculated odds ratio from an ordered Logit model for star ratings, and calculated the linear strength of association for QIP. We adjusted for facility size, profit status, and home dialysis status. Peer-to-peer counseling was not analyzed due to a large proportion of non-reported data.

Results

From a total of 6750 dialysis facilities nationally, 6027 had star ratings (1 - low to 5 - high), 6229 facilities had QIP score and 3354 facilities had CAHPS survey results. CAHPS domains related to preceived facility delivery of care (staff and operations) were consistently stronger predictors of a 5-star rating or high QIP than domains related to perceived delivery of care by nephrologists, Table.

Conclusion

Patient's perception of care delivery, captured by CAHPS, is directly related to the known quality measures-- star ratings and QIP. Interestingly the facility staff and environment are stronger predictors of quality than nephrologists. Understanding patients' perception of care may help with their engagement to ultimately reach important quality goals.

CAHPS5 Star
(Odds Ratio)*
QIP
(β-coefficient)*
Nephrologist-Related Domains 
Patients rating nephrologists’ communication and caring1.4612.79
Patients rating of the nephrologist1.3411.79
Facility-Related Domains 
Patients rating of quality of dialysis center care and operations1.9832.86
Patients rating of the dialysis center staff1.7024.71
Patients rating of the dialysis facility1.7626.28

* p < 0.001

Funding

  • NIDDK Support