Improving School Leadership: The Promise of Cohesive Leadership Systems

Describes Wallace grantees' work to create a cohesive leadership system of coordinated policies between states and districts and across state agencies, states' and districts' efforts to forge cohesive policies, and the impact on instructional leadership

Development, methodology, and adaptation of the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS (R)) patient experience survey, 2007-2019

AbstractThe Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys collect standardized information about patient experiences of care from nationally representative samples of people with Medicare to support consumers’ enrollment choices and enable the Centers for Medicare & Medicaid Services to monitor care quality and incentivize high quality patient-centered care. Since 2007, protocols for data collection, analysis, and reporting have evolved to address expanded Medicare coverage options and a shift from a single survey vendor to a model in which health plans hire approved vendors to administer the survey. During that time, response rates for all types of surveys have declined; increasing effort has gone toward increasing survey participation, especially among people whose preferred language is not English. In this paper, we describe the history, goals, and current use of the Medicare CAHPS surveys. We also summarize key methodological issues, such as sample design, field implementation and data cleaning, adjustment, scoring, and report production. Additionally, we discuss issues that may arise more generally in managing a large, annual national survey that has direct impact on policy, and consider how a long-running survey of this nature may need to evolve to reflect changes in health care delivery and promote standardization in survey administration while maintaining survey content

Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures.

BackgroundPrior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices.ObjectiveEstimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals.DesignMixed-effect regression models in cross-sectional data.Participants2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes.Main measuresCare coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c <9%, LCL-C<100 mg/dL), glaucoma screening in older adults, BMI assessment, osteoporosis management for women with a fracture, and rheumatoid arthritis therapy.Key resultsFor 9 of the 13 HEDIS measures, within health plans, beneficiaries who reported better care coordination also received better clinical care (p<0.05) and none of the associations went in the opposite direction; HEDIS differences between those with excellent and poor coordination exceeded 5 percentage points for 7 measures. Nine measures had positive associations (breast cancer screening, colorectal cancer screening, cardiovascular care LDL-C screening, 4 of 5 diabetes care measures, osteoporosis management, and rheumatoid arthritis therapy).ConclusionsWithin health plans, beneficiaries who report better care coordination also received higher-quality clinical care, particularly for care processes that entail organizing patient care activities and sharing information among different healthcare providers. These results extend prior research showing that health plans with better beneficiary-reported care coordination achieved higher HEDIS performance scores