THEME 1- LECTURE 2:
Measuring Patient Satisfaction Among Culturally Diverse Populations
Increasing the ability of consumer surveys to capture the experiences
and ratings of patients of color, a project of the California Pan-Ethnic
Health Network and the California HealthCare Foundation Quality Initiative.
Expert panel supported by Foundation staff and survey developers and researchers
examined the potential for consumer surveys (CAHPS©, Picker and Physician
Value Check to contribute to an assessment of the cultural competence
of surveyed organizations. Project results included findings concerning
the strengths and limitations of standardized surveys in contributing
to assessments of cultural competence. The project also developed a set
of recommendations to maximize the usefulness of existing surveys and
data, increase their ability to gather information from culturally diverse
communities, and employ non-standardized tools as appropriate.
Calvin Freeman is Principal of Calvin Freeman
and Associates, a health policy consultant firm dedicated to improvements
to the health status of multicultural communities. He was the first Chief
of the Office of Multicultural Health in the California Department of
Health Services. In that role, he was part of a team of DHS staff and
community advocates who formulated the most significant language access
standards for Medicaid managed care contractors in the United States.
Mr. Freeman previously led California's disaster medical preparedness
program and, more recently, was Vice President for Strategic Resources
of The California Endowment. He has a B.A. in Mathematics and Economics
and a MAT from Reed College in Portland, Oregon, with additional graduate
work at the University of Wisconsin. He is a President Elect of the California
Public Health Association - North and is the President of the Sacramento
Black Health Network. He was awarded the first Bert Campbell Award for
Contributions to Multicultural Health by the California Pan-Ethnic Health
Network and is currently a member of that organization's Board of Directors.
Mr. Freeman is from St. Louis, Missouri.
Calvin Freeman
Calvin Freeman and Associates
Voice: (916) 383-6944
Fax: (916) 383-6922
Email: scyfreeman@worldnet.att.net
Objective
To examine racial/ethnic group differences in consumer reports and
ratings of care using data from the National CAHPS Benchmarking Database
(NCBD) 1.0.
Data Sources
Adult data from the NCBD 1.0 is comprised of CAHPS 1.0 survey data
from 54 commercial and 31 Medicaid health plans from across the United
States. A total of 28,354 adult respondents (age18 years) were included
in this study. Respondents were categorized as belonging to one of the
following racial/ethnic groups: Hispanic (n=1,657); non-Hispanic White
(n=20,414); Black or African-American (n=2,942); Asian and Pacific Islander
(n=976); American Indian and Alaskan Native (n=588); and Other racial/ethnic
group or Multiracial (n=553). Persons who failed to indicate any racial/ethnic
background were placed in a śMissing” category (n=1,224).
Study Design
Four single item global ratings (personal doctor; specialty care;
overall rating of health plan; and overall rating of health care) and
five multiple item report composites (access to needed care; provider
communication; office staff helpfulness; promptness of care; and health
plan customer service) from the CAHPS 1.0 surveys were assessed.
Statistical Analyses
Multiple regression models were estimated to assess differences in
global ratings and report composites between whites and members of other
racial/ethnic groups, controlling for age, gender, perceived health status,
educational attainment, and insurance type.
Principal Findings
Whites were more positive in reports about most aspects of care than
members of other racial/ethnic groups. Inter-racial/ethnic group differences
were diminished in global ratings of care.
Conclusions
Improvements in quality of care for racial/ethnic minority groups
are needed. Comparisons of care in diverse populations based on global
ratings of care should be interpreted cautiously.
Leo S. Morales, MD, PhD is a UCLA Assistant Professor
of Medicine and RAND Health Consultant. Dr. Morales received an MD from
the University of Washington School of Medicine, and MPH from the University
of Washington School of Public Health and Community Medicine. He recently
earned his PhD from RAND Graduate School where he pursued his research
interests in satisfaction with care and health-related quality of life
applied to urban poor and underserved minority populations.
Dr. Morales is currently the PI of a Robert Wood Johnson funded validation
study of the Spanish CAHPS 2.0 Surveys and is the recipient of a minority
investigator supplemental grant from the Agency for Healthcare Research
and Quality to the RAND Consumer Assessment of Health Plans Study to study
the equivalence of the English and Spanish versions of the CAPHS 2.0 surveys.
He has conducted multiple studies evaluating the measurement equivalence
among non-Hispanic White and Hispanic respondents to the Medical Quality
Commission physician group patient satisfaction survey instrument (Hays,
Brown, et. al., 1998).
Dr. Morales is of Bolivian heritage and is a native Spanish speaker.
He has many years of experience providing primary care and hospital care
to mostly uninsured and ethnically and linguistically diverse populations.
He has held a clinical faculty appointment in the Department of Medicine
at UCSF, and continues to see patients and supervise medical residents
at UCLA Medical Center.
Leo S. Morales, MD, PhD
Assistant Professor
University of California at Los Angeles
Consultant, RAND Health Program
911 Broxton Plaza, Box 951736
Los Angeles, CA 90095-1736
Phone: (310) 794-2296
Fax: (310) 794-0722
Email: morales@rand.org
Tom Delbanco, MD
Richard and Florence Koplow Á James Tullis Professor of General Medicine
and Primary Care, Harvard Medical School;
Chief, Division of General Medicine & Primary Care, Beth Israel
Deaconess Medical Center;
Founding Chair, The Picker Institute
330 Brookline Avenue
Boston, MA 02215
Phone: (617) 667-3992
Fax: (617) 667-2854
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