298 - Understanding How Patients Experience Telemedicine Visits: A New Child Clinician and Group CAHPS Survey

Poster Number: 298
Publication Number: 298.1634

Background: Telemedicine has become an integral part of how medical care is delivered in the United States, but much more needs to be learned about how pediatric patients experience virtual visits and there is no validated pediatric patient experience survey for this visit modality.

Objective: To adapt the CAHPS Clinician & Group Child Survey to assess both virtual and in-person encounters at the visit level.

Design/Methods: We conducted 10 focus groups in 2021 with parents of children who had a telemedicine visit within the past 3 months (8 English, 2 Spanish), and 1 focus group with adolescents. Based on formative work and focus group findings, we drafted a visit-based survey. We then conducted 20 cognitive interviews (15 English, 5 Spanish) and survey items were revised based on findings from cognitive interviews. We conducted a field test of the revised survey in 34 clinics across three states for both virtual and in-person visits from 1/22-7/22. Psychometric testing was done to determine which items would be included in the final survey instrument and to develop composite measures. We developed a case-mix adjustment model to account for differences in responses between clinics.

Results: We collected 1,661 field test surveys with complete data on at least one survey measure. There was an average of 49 responses per clinic, with broad representation of child and respondent characteristics (Table 1). 13.5% of all visits were conducted virtually. Mean top-box clinic-level patient experience scores vary from 78.0% (“Visit Convenience”) to 97.0% (“Efficacy of Visit Technology”; Table 2). Most composite and single-item measures demonstrated good-to-excellent clinic-level reliability at 300 responses per clinic (average 0.71, range 0.40-0.91), indicating the survey’s ability to distinguish high and low performers on corresponding dimensions of patient experience. Individual composite-to-composite correlations were mainly positive with higher correlations among measures of communication and shared decision-making (Table 3). Our final model was case-mix adjusted for respondent age, respondent education, and child global health status. Based on quantitative analyses, the final survey instrument contains 52 items categorized into 10 composite and single-item measures.

Conclusion(s): The CAHPS C&G Child Visit Survey was developed to be a publicly available standardized survey of pediatric virtual and in-person visit-level experience of care. It can be used to benchmark virtual and in-person pediatric outpatient experience across clinics and assist in efforts to improve the quality of outpatient care.