The five-year study, funded to the tune of $10 million by the Agency for Health Care Policy and Research (AHCPR), brings together researchers from the RAND, Research Triangle Institute, and Harvard University to develop the protocols to measure consumer satisfaction of health plans.
"An important product of the research will be a survey kit that will be available (in the public domain) for assessing consumer satisfaction with health plans," explained Ian Coulter, PhD, a health services researcher with the RAND Corp. in Santa Monica, California.
Patient satisfaction will be examined in fee-for-service plans, HMOs, and public health clinics. But with chiropractic once again left out the loop, the decision making models that will be developed will provide no feedback on patient satisfaction with chiropractic. This translates to chiropractic being on the outside looking in, and being considered as a not necessary add-on service, with the result of being excluded from inclusion in the managed care juggernaut.
In response to this exclusion, several important events occurred almost simultaneously:
- John Triano, DC,MA, who has served as a member of two AHCPR guidelines panels, contacted the Agency to determine the potential for chiropractic inclusion in the CAHPS project.
- Researchers Ian Coulter, PhD, and Ronald Hays, PhD, both of the RAND Corp., began to explore the possibility of a parallel CAHPS project for chiropractic.
- The American Chiropractic Association addressed their concerns with the AHCPR for excluding chiropractic from the CAHPS project.
- The National Chiropractic Mutual Insurance Company (NCMIC) Research Committee (comprised of Louis Sportelli, DC, Marino "Bud" Passero, DC, and Arnold Cianciulli, DC) looked into the possibility of funding such a study for chiropractic, should chiropractic's addition to the AHCPR study be unsuccessful.
As expected, getting chiropractic included in the original CAHPS study at this stage was not an option. The next best choice was to develop a parallel study (utilizing many of the same researchers from the CAHPS team) that would develop methodology to measure consumer satisfaction of chiropractic care, and a survey kit to supplement the CAHPS packets.
The advantages of a parallel chiropractic satisfaction study are two-fold: (1) insure the study of chiropractic satisfaction (currently the only non-medical care being studied); and (2) insure the development of a specific chiropractic satisfaction kit to be used by health care purchasers.
"The chiropractic study will parallel the larger study in the development of a chiropractic-targeted kit for assessing satisfaction," said Dr. Ian Coulter. "The development of this kit will involve a rigorous process of item selection through interviews, focus groups, and cognitive testing to maximize reliability and validity. Although satisfaction instruments are available for chiropractic, none have yet been subjected to this comprehensive process of development and evaluation. The final kits will include the survey materials and a user manual describing both the use and the interpretation of survey results."
"The significance of having an instrument for chiropractic cannot be measured," said NCMIC President Louis Sportelli, DC. "Without a chiropractic kit developed with the same criteria as the original study, there would be no way chiropractic data could be obtained by groups wanting to assess chiropractic services, effectively making chiropractic care a non-issue.
With all of the needed expertise available, there was still the usual problem of money. This is where NCMIC is playing the critical role. "NCMIC funded this project because we saw the benefits to the chiropractic profession to be beyond measure," explained Dr. Louis Sportelli. "This will be one of the few, if not the only, opportunity for health care consumers to demonstrate the need and value of our services."
Reference
1. Chiropractic left out of CAHPS study! Dyn Chiro, April 8, 1996.
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