Questions & Answers: The CAHPS Patient Narrative Elicitation Protocol

A Scientific Approach to Collecting Comments on Experiences of Care

Questions and Answers: The CAHPS Patient Narrative Elicitation Protocol: A Scientific Approach to Collecting Comments on Experiences of Care (PDF, 159 KB)

Narratives from patients about their health care experiences can provide a valuable complement to standardized survey scores, both to help clinicians understand what they can do to improve their care and to inform patients about the clinicians available to them. However, the unscientific way in which patients’ comments are commonly collected, whether by health care systems or provider review sites, tends to result in information that is neither representative of patients’ experiences nor a full account of those experiences.

To help address this concern, the Agency for Healthcare Research and Quality (AHRQ) has released the beta version of the CAHPS Patient Narrative Elicitation Protocol, a structured series of open-ended questions designed to be added to the CAHPS Clinician & Group Survey. The Elicitation Protocol prompts patients to provide a clear and comprehensive description of their experiences with their health care providers and medical office staff. It represents a significant step towards collecting patient narratives in a way that is as scientifically grounded and rigorous as the CAHPS closed-ended questions that are used to gather standardized data on patient experience. Applying a high standard of scientific rigor to the collection of open-ended survey responses can ensure that the resulting information has value to consumers trying to assess their options as well as providers seeking to better understand how their patients experience care.

Where Can I Find the CAHPS Patient Narrative Elicitation Protocol?

The Elicitation Protocol and instructions for using these supplemental items with the CAHPS Clinician & Group Survey are available on the AHRQ CAHPS Web site: CAHPS Patient Narrative Elicitation Protocol.

How Many Questions Are in the Elicitation Protocol?

The Adult version of the Elicitation Protocol has five questions:

PN-1. What are the most important things that you look for in a healthcare provider and the staff in his or her office?

PN-2. When you think about the things that are most important to you, how do your provider and the staff in his or her office measure up?

PN-3. Now we’d like to focus on anything that has gone well in your experiences in the last 6 months with your provider and the staff in his or her office. Please explain what happened, how it happened, and how it felt to you.

PN-4. Next we’d like to focus on any experiences in the last 6 months with your provider and the staff in his or her office that you wish had gone differently. Please explain what happened, how it happened, and how it felt to you.

PN-5. Please describe how you and your provider relate to and interact with each other.

The Child version of the Elicitation Protocol adds a sixth question that asks how the child and provider relate to each other.

Can I Use These Questions With Any CAHPS Survey?

At this time, the CAHPS Patient Narratives Elicitation Protocol is intended for use with the CAHPS Clinician & Group Survey only. It is automatically downloaded with the 3.0 version of that survey: Download the CG-CAHPS Survey 3.0 and Instructions.

Can I Use These Questions Without a CAHPS Survey?

Yes, the Elicitation Protocol can be implemented on its own to gather more detailed feedback from specific patient populations or to obtain information about patient experience in between administrations of the CAHPS Clinician & Group Survey.

Who Developed the Elicitation Protocol?

AHRQ funded the development of the Elicitation Protocol by researchers affiliated with the Yale School of Public Health, RAND, and the University of Wisconsin–Madison.

You can find information on the development of the Elicitation Protocol on the AHRQ CAHPS Web site and in Grob R, Schlesinger M, Parker AM, et al. Breaking narrative ground: Innovative methods for rigorously eliciting and assessing patient narratives. Health Serv Res 2016 April; 51:1475–6773.

Where Can I Find More Information About the Elicitation Protocol and the Use of Patient Narratives?

Grob R, Schlesinger M, Parker AM, et al. Breaking narrative ground: Innovative methods for rigorously eliciting and assessing patient narratives. Health Serv Res 2016 Apr;51:1475–6773.
Kanouse DE, Schlesinger M, Shaller D, et al. How patient comments affect consumers’ use of physician performance measures. Med Care 2016 Jan;54(1):24–31.
Schlesinger M, Grob R, Shaller D. Using patient-reported information to improve clinical practice. Health Serv Res 2015 Dec;50(S2):2116–54.
Schlesinger M, Grob R, Shaller D, et al. Taking patients’ narratives about clinicians from anecdote to science. N Engl J Med 2015 Aug;373(7):675–9.
Schlesinger M, Kanouse DE, Martino SC, et al. Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior. Med Care Res Rev 2014;71:Suppl:38S–64S.
Schlesinger M, Kanouse DE, Rybowski L, et al. Consumer response to patient experience measures in complex information environments. Med Care 2012;50:S56–S64.

What If I Have Other Questions?

Please visit the AHRQ CAHPS Web site or contact the CAHPS Help Line at cahps1@westat.com or 1–800–492–9261.

Page last reviewed January 2017
Page originally created January 2017

Internet Citation: Questions & Answers: The CAHPS Patient Narrative Elicitation Protocol. Content last reviewed January 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/surveys-guidance/item-sets/elicitation/qa.html