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Abstract: PO1072

Longitudinal Assessment of Random Variability in ICH-CAHPS Scores

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Cohen, Dena E., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

The Centers for Medicare & Medicaid Services mandates use of the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey to assess dialysis patients’ experience of care. Survey responses, collected twice annually and reported at the facility level, are intended to evaluate facility performance over time and to compare across facilities at a given time. In order to be useful for these purposes, the random variability in ICH-CAHPS scores must be relatively low.


ICH-CAHPS scores were analyzed among 2735 facilities managed by a large dialysis organization that had at least one ICH-CAHPS score available between 2014 and 2018. The association between Center Global Rating score (1 of the 6 ICH-CAHPS domains) and survey period was assessed using a mixed model with random slopes and intercepts for each facility. Mean squared residuals were calculated for each facility and categorized on the basis of the number of survey responses received at the facility. Facilities with available scores in all 9 survey periods analyzed (N = 1074) were assigned to quintiles based on their position within the distribution of scores in each survey period, and movement across quintiles was assessed longitudinally.


The mean Center Global Rating score in the fall of 2018 was 64.9, with an average increase of 0.2 points per period over the subsequent 8 survey periods. However, random variation in scores was considerable and dependent on the number of survey responses received. The root mean square error, a measure of random variation, ranged from 6.9 points for facilities with >27 responses to 9.2 points for facilities with 11 to 12 responses. Among facilities with survey responses available in all 9 periods, movement between quintiles was frequent, with 39.7% of facilities occupying 4 of the 5 possible quintiles at least once, and 11.5% occupying all 5 quintiles.


Within facilities, there is substantial random variation in ICH-CAHPS scores over time. This diminishes the utility of ICH-CAHPS for its intended purposes. Improvements to ICH-CAHPS, or development of alternative measures of patient experience, are needed to enable accurate assessment of facility performance and to inform patient care.