PONE-D-20-24361

Development and psychometric properties of the Japanese Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS)

PLOS ONE

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2. In your methods section you indicate that "informed consent was not obtained because this is an analysis of existing anonymous data." However, you also mention that you excluded from this survey, patients who visited the participating clinics for the first time. There is significant discord between your two statements. Please clarify whether you collected primary data or secondary data? If primary data collection was done, please justify why informed consent was not obtained. If this is secondary data analysis, please explain if data were de-identified/ anonymised before access.

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"I have read the journal's policy and the authors of this manuscript have the following competing interests: Mr. Kuichiro Taguchi and Mr. Eiichi Hama are an employee of EPARK. "

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a well done study and nicely described paper. However, I have several suggestions to improve the work.

1) It is good to see that the authors acknowledge the provider-level measurement when computing correlations among the CAHPS measures. But they also need to report physician-level reliability estimates. Categorical factor analysis (polychoric correlations) should be conducted. The text about coefficient alpha on lines 213-216 is incorrect and should be deleted. Yes, alpha will increase with the number of items as long as they are positively correlated with one another, but the fact still remains that a shorter test with low reliability has low reliability. Because of what is noted above about the use of CAHPS, the important reliability estimate is the one directed at the unit of application of the measure (provider-level).

2) Most of their results jive with what has been found in CAHPS before (e.g., low internal consistency reliability for care coordination, strongest correlations of communication with overall provider rating). Referring back to other literature that has shown this would be helpful.

3) How as the survey distributed and where (line 78)?

4) What is mean by "within two days of the survey period" (line 79)?

5) How was it determined that potential respondents had a "severe physical or mental" (line 81) disorder?

6) When the authors refer to the Japanese version of the C-G CAHPS survey (e.g., line 68) they should make it clear that they are referring to the CAHPS Clinician & Group Survey 3.0 that asks patients about their experiences with care from an ambulatory care provider over a six-month period. (Don't wait until line 89). Relatedly, reference 10 is for another C-G survey, not the one used in this study. Some references that are relevant are the following. These references refer to the patient-centered medical home survey but the C-G items are embedded within it:

Scholle, S. H., et al. (2012). Development of and field-test results for the CAHPS PCMH survey. Medical Care, 50, S2-10.

Hays, R. D., et al. (2014). Evaluating the psychometric properties of the CAHPS patient-centered medical home survey. Clinical Therapeutics, 36 (5), 689-696. PMCID: PMC4087122.

And on lines 81-82 when it is mentioned that those visiting the clinic for the first time were excluded, say why. Given that the survey asks about care during the last 6 months, why did were those who had a duration of less than 6 months (33% of the sample, Table 1) included in the study?

7) The fit cutoffs indicated are dated. See somewhat more recent thresholds such as: Reeve, B. B. et al.(2007). Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcome Measurement Information System (PROMIS). Medical Care, 45, S22-31.

Also:

* When the CAHPS abbreviation is used the first time, the registered copyright symbol should follow it.

"consistently associated with" (line 52)

- In what direction?

* What does "confirmed its validity and reliability" (line 57)and a "valid and reliable scale" (line 233) mean? Reliability and validity are not dichotomous attributes.

* "Physician Compare website" (line 60) -> Center for Medicare & Medicaid Services Physician

Compare website.

* The never to always response scale is a polytomous, but it is not a "Likert scale": http://www.john-uebersax.com/stat/likert.htm

* The 0-100 possible range score is not "normalized" in the psychometric or statistical sense so I would not describe it is such (line 109, 113).

Reviewer #2: Thank you for the opportunity to review your manuscript. I found it to be generally well-written. I would appreciate some clarification on a small number of issues, as below:

Material and methods

Page 10 Line 74

Please explain how you selected the 11 internal medicine clinics. Are there any characteristics for the physicians among the selected 11 clinics? In Japan, physicians’ practice depends on their physician’s career.

Measures

Page 11 Line 98

For the cross-cultural adaptation of the development of questionnaires, conducting the back-translation process is mostly included as follows.

https://journals.lww.com/spinejournal/Fulltext/2000/12150/Guidelines_for_the_Process_of_Cross_Cultural.14.aspx

Did you do back-translation or remove the backward translation process?

If you removed the backward translation process, please explain.

Discussion

Page 19 Line 214-215

Are there any other reasons why Cronbach’s alpha for Coordination did not exceed the recommended value? For example, the each items’ difference or characteristics among the scale.

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Reviewer #1: Yes: Ron D. Hays

Reviewer #2: No

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Development and psychometric properties of the Japanese Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS)

PONE-D-20-24361R1

Dear Dr. Aoki,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Stefan Hoefer

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

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Reviewer #2: No