for their effectiveness in bringing about changes in practice. The 14 projects under TRIP I focus on strategies for collecting data, while the 27 projects under TRIP II examine implementation strategies and their effectiveness in achieving practice changes among providers with different characteristics and clinical populations across diverse settings (Agency for Healthcare Research and Quality, 2000).
In addition to performance and outcome measurement, there has recently been increased interest in improving the use of comparative quality data by patients, purchasers, providers, and policy makers as a quality improvement tool. As interest has grown in evaluating patient perceptions of the care they receive to inform the future selection of health plans, AHRQ has begun working to develop and validate surveys of patient perceptions and to display their results to consumers in useful ways. Research examining patient perceptions of care and its relationship to improved quality is evolutionary. AHRQ’s development of instruments to measure consumer perceptions is an early step towards creating well-tested and validated instruments in the public domain to inform consumer choices.
AHRQ initially sponsored the Consumer Assessment of Health Plans Survey (CAHPS) to query Medicaid and commercial insurance beneficiaries on their experiences in managed care plans. As the role of managed care plans in Medicare grew, AHRQ and CMS worked collaboratively to ensure that the experience of Medicare beneficiaries would be captured in CAHPS. The CAHPS results are available on the Web and in print (Agency for Healthcare Research and Quality, 2000). The core of the CAHPS surveys is now applied to other federal programs and the private sector, with questions being added to tailor the survey to specific issues that may be more relevant to specific programs or populations.
CAHPS now includes surveys of Medicare beneficiaries who have disenrolled from Medicare+Choice plans to determine their reasons for doing so. A CAHPS survey first released in the fall of 2000 reported the experiences of Medicare beneficiaries in fee-for-service (FFS) Medicare. This survey was designed to enable comparisons of the performance of the FFS and managed care sectors as a whole on selected indicators within a geographic area. Through collaborations with other agencies and private organizations, CAHPS has also been adapted for applications by the Federal Employees Health Benefit Plan. CAHPS is the most widely used report of consumer ratings of health plans (Hibbard et al., 2002).
Research and development efforts for CAHPS are ongoing, and projects are currently under consideration for the second phase of the initiative (CAHPS II). Research is also underway to better understand how the information from consumer surveys can be used by QIOs to target quality improvement projects for providers (Garg et al., 2000). In the fu-