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Developing an Illustrated Version of the Consumer Assessment of Health Plans (CAHPS ® )

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Background: The most commonly used tool for assessing member satisfaction with health plans in the United States is the Consumer Assessment of Health Plans (CAHPS®). Yet its complexity exceeds the abilities of many patient populations. An illustrated version of the CAHPS® instrument was designed for lowliteracy audiences; the illustrations were tested and were then revised to reflect respondents' feedback.

Methods: Illustrations were developed to support the central themes in each of 63 CAHPS® text items. The cognitive testing approach was used to create a systematic method to analyze key features of an item and develop the corresponding interview procedure.

Results: Following cognitive interviews on subsets of illustrations and items with more than 900 patients, all but 7 (11%) of the 63 items met the criterion that no more than 25% of the sample who saw the illustration could be rated as having "limited/no understanding." By the final pilot, a median of 66% had "full understanding," 20% had "partial understanding," and 14% had "limited/no understanding" of the 43 illustrations needing revision.

Conclusions: The protocol helped improve the respondents' understanding of the illustrations. The experiences and lessons learned can guide design of illustration-enhanced materials for lowliteracy populations.

Document Type: Research Article

Publication date: January 1, 2005

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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