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Mathews M, Beckett MK, Martino SC, Brown JA, Orr N, Gaillot S, Elliott MN. Medicare Advantage enrollees' reports of unfair treatment during health care encounters. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae063. [PMID: 38812985 PMCID: PMC11135643 DOI: 10.1093/haschl/qxae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated whether they were treated unfairly in a health care setting based on any of 10 personal characteristics. We calculated reported unfair treatment rates overall and by enrollee characteristics. Nine percent of respondents reported any unfair treatment, most often based on health condition (6%), disability (3%), or age (2%). Approximately 40% of those reporting any unfair treatment endorsed multiple categories. People who qualified for Medicare via disability reported unfair treatment by disability, age, income, race and ethnicity, sex, sexual orientation, and gender/gender identity more often than those who qualified via age. Enrollees dually eligible for Medicare and Medicaid or eligible for a Low-Income Subsidy (DE/LIS) reported unfair treatment by disability, income, language/accent, race and ethnicity, culture/religion, and sex more often than non-DE/LIS enrollees. Compared with White respondents, racial and ethnic minority respondents more often reported unfair treatment by race and ethnicity, language/accent, culture/religion, and income. Female respondents were more likely than male respondents to report unfair treatment based on age and sex.
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Affiliation(s)
- Megan Mathews
- RAND Corporation, Arlington, VA 22202, United States
| | | | | | - Julie A Brown
- RAND Corporation, Santa Monica, CA 90401, United States
| | - Nate Orr
- RAND Corporation, Santa Monica, CA 90401, United States
| | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD 21244, United States
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Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS One 2024; 19:e0296062. [PMID: 38180988 PMCID: PMC10769059 DOI: 10.1371/journal.pone.0296062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. OBJECTIVES To examine the association between patient satisfaction with healthcare and adherence to antidepressants. METHODS A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). RESULTS Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). CONCLUSIONS Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.
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Affiliation(s)
- Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, United States of America
| | - Mary Bynum
- Healthcare Management, Franklin University, Columbus, Ohio, United States of America
| | - Ameena Kemavor
- ADAMH Board of Franklin County, Columbus, OH, United States of America
| | - Norah L. Crossnohere
- Division of General Internal Medicine, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - John Bridges
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
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3
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Quigley DD, Elliott MN, Slaughter ME, Talamantes E, Hays RD. Shadow Coaching Improves Patient Experience for English-Preferring Patients but not for Spanish-Preferring Patients. J Gen Intern Med 2023; 38:2494-2500. [PMID: 36797540 PMCID: PMC10465456 DOI: 10.1007/s11606-023-08045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shadow coaching, a type of one-on-one provider counseling by trained peers, is an effective strategy for improving provider behaviors and patient interactions, but its effects on improving patient experience for English- and Spanish-preferring patients is unknown. OBJECTIVE Assess effects of shadow coaching on patient experience for English- and for Spanish-preferring patients. DESIGN We analyzed 2012-2019 Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) data (n=46,089) from an urban Federally Qualified Health Center with 44 primary care practices and 320 providers. One-third (n=14,631) were Spanish-preferring patients. We fit mixed-effects regression models with random effects for provider (the level of treatment assignment) and fixed effects for time (a linear spline for time with a knot and "jump" at coaching date), patient characteristics, and site indicators, stratified by preferred language. PARTICIPANTS The 74 providers who had a 6-month average top-box score on the CAHPS overall provider rating below 90 (on a 100-point scale) were shadow coached. Similar percentages of English-preferring (45%) and Spanish-preferring patients (43%) were seen by coached providers. INTERVENTION Trained providers observed patient care by colleagues and provided suggestions for improvement. Verbal feedback was provided immediately after the observation and the participant received a written report summarizing the comments and recommendations from the coaching session. MAIN MEASURES CG-CAHPS Visit Survey 2.0 provider communication composite and overall provider rating (0-100 scoring). KEY RESULTS We found a statistically significant 2-point (small) jump in CAHPS provider communication and overall provider rating among English-preferring patients of coached providers. There was no evidence of a coaching effect on patient experience for Spanish-preferring patients. CONCLUSIONS Coaching improved care experiences for English-preferring patients but may not have improved patient experience for Spanish-preferring patients. Selection and training of providers to communicate effectively with Spanish-preferring patients is needed to extend the benefits of shadow coaching to Spanish-preferring patients.
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Affiliation(s)
| | - Marc N. Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | | | | | - Ron D. Hays
- UCLA David Geffen School of Medicine & Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736 USA
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Rivlin K, Brenner-Levoy J, Odum T, Muzyczka Z, Norris A, Norris Turner A, Bessett D. Provider Mistrust and Telemedicine Abortion Care Preferences Among Patients in Ohio, West Virginia, and Kentucky. Telemed J E Health 2023; 29:414-424. [PMID: 35856859 PMCID: PMC10081726 DOI: 10.1089/tmj.2022.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The convenience and privacy provided by telemedicine medication abortion may make this service preferable to patients who mistrust their abortion provider. We assessed associations between mistrust in the abortion provider and preferences for telemedicine abortion. Study Design: From April 2020 to April 2021, we surveyed patients seeking abortion in Ohio, West Virginia, and Kentucky. Using unconditional logistic regression models, we examined unadjusted and adjusted associations between mistrust in the abortion provider and preferences for telemedicine abortion among all participants, and among only participants undergoing medication abortion. Results: Of 1,218 patients who met inclusion criteria, 546 used medication abortion services. Just more than half (56%) of all participants and many (64%) of medication abortion participants preferred telemedicine services. Only 6% of medication abortion participants received telemedicine medication dispensing services. Only 1.4% of all participants and 1% of medication abortion participants mistrusted the abortion provider. Participants who mistrusted the abortion provider were somewhat more likely to prefer telemedicine abortion (unadjusted odds ratio [OR]: 2.5, 95% CI: 0.8-7.9; adjusted OR: 2.9, 95% CI: 0.9-9), and medication abortion participants who mistrusted the abortion provider were also somewhat more likely to prefer telemedicine abortion (unadjusted OR: 3.5, 95% CI: 0.4-28.9; adjusted OR: 5.0, 95% CI: 0.6-43), although these associations were not statistically significant. Conclusions: In three abortion-restrictive states, most patients expressed preferences for telemedicine abortion, but few accessed them. Provider mistrust was rare, but those experiencing mistrust trended toward preferring telemedicine services. Telemedicine may improve access to abortion services for patients experiencing medical mistrust.
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Affiliation(s)
- Katherine Rivlin
- Department of Obstetrics and Gynecology, The College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Tamika Odum
- Behavioral Science Department, Blue Ash College, University of Cincinnati, Cincinnati, Ohio, USA
| | - Zoe Muzyczka
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Abigail Norris Turner
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
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Strassle PD, Stewart AL, Quintero SM, Bonilla J, Alhomsi A, Santana-Ufret V, Maldonado AI, Forde AT, Nápoles AM. COVID-19-Related Discrimination Among Racial/Ethnic Minorities and Other Marginalized Communities in the United States. Am J Public Health 2022; 112:453-466. [PMID: 35196054 PMCID: PMC8887166 DOI: 10.2105/ajph.2021.306594] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the prevalence of COVID-19-related discrimination among major US racial/ethnic groups and estimate associations between discrimination, race/ethnicity, and other sociodemographic characteristics. Methods. We conducted a nationally representative online survey of 5500 American Indian/Alaska Native, Asian, Black/African American, Hawaiian/Pacific Islander, Latino (English and Spanish speaking), White, and multiracial adults from December 2020 to February 2021. Associations between sociodemographic characteristics and COVID-19-related discrimination were estimated via multinomial logistic regression. Results. A total of 22.1% of the participants reported experiencing discriminatory behaviors, and 42.7% reported that people acted afraid of them. All racial/ethnic minorities were more likely than White adults to experience COVID-19-related discrimination, with Asian and American Indian/Alaska Native adults being most likely to experience such discrimination (discriminatory behaviors: adjusted odd ratio [AOR] = 2.59; 95% confidence interval [CI] = 1.73, 3.89; and AOR = 2.67; 95% CI = 1.76, 4.04; people acting afraid: AOR = 1.54; 95% CI = 1.15, 2.07; and AOR = 1.84; 95% CI = 1.34, 2.51). Limited English proficiency, lower education, lower income, and residing in a big city or the East South Central census division also increased the prevalence of discrimination. Conclusions. COVID-19-related discrimination is common, and it appears that the pandemic has exacerbated preexisting resentment against racial/ethnic minorities and marginalized communities. Efforts are needed to minimize and discredit racially driven language and discrimination around COVID-19 and future epidemics. (Am J Public Health. 2022;112(3):453-466. https://doi.org/10.2105/AJPH.2021.306594).
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Affiliation(s)
- Paula D Strassle
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Anita L Stewart
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Stephanie M Quintero
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Jackie Bonilla
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Alia Alhomsi
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Verónica Santana-Ufret
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Ana I Maldonado
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Allana T Forde
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
| | - Anna María Nápoles
- Paula D. Strassle, Stephanie M. Quintero, Jackie Bonilla, Alia Alhomsi, Verónica Santana-Ufret, Ana I. Maldonado, Allana T. Forde, and Anna María Nápoles are with the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Anita L. Stewart is with the Center for Aging in Diverse Communities, Institute for Health & Aging, University of California, San Francisco
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Chang TJ, Bridges JFP, Bynum M, Jackson JW, Joseph JJ, Fischer MA, Lu B, Donneyong MM. Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design. J Am Heart Assoc 2021; 10:e019943. [PMID: 34238022 PMCID: PMC8483480 DOI: 10.1161/jaha.120.019943] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background We assessed the associations between patient-clinician relationships (communication and involvement in shared decision-making [SDM]) and adherence to antihypertensive medications. Methods and Results The 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient-clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self-reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey-weighted multivariable-adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient-clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty-five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient-clinician communication (OR, 1.38; 95% CI, 1.14-1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08-1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications. Conclusions Patient-clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.
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Affiliation(s)
| | - John F P Bridges
- Department of Biomedical Informatics Ohio State College of Medicine Columbus OH
| | - Mary Bynum
- Healthcare Management Franklin University Columbus OH
| | - John W Jackson
- Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Joshua J Joseph
- College of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham & Women's Hospital Boston MA
| | - Bo Lu
- College of Public Health Ohio State University Columbus OH
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Greene J, Ramos C. A Mixed Methods Examination of Health Care Provider Behaviors That Build Patients' Trust. PATIENT EDUCATION AND COUNSELING 2021; 104:1222-1228. [PMID: 32994105 DOI: 10.1016/j.pec.2020.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient trust in health care providers is associated with better health behaviors and utilization, yet provider trust has not been consistently conceptualized. This study uses qualitative methods to identify the key health provider behaviors that patients report build their trust, and data from a national U.S. survey of adults to test the robustness of the qualitative findings. METHODS In this mixed methods study, we conducted 40 semi-structured interviews with a diverse sample to identify the provider behaviors that build trust. We then analyzed a nationally representative survey (n = 6,517) to examine the relationship between respondents' trust in their usual provider and the key trust-related behaviors identified in the qualitative interviews. RESULTS Interviewees reported that health providers build trust by communicating effectively (listening and providing detailed explanations), caring about their patients (treating them as individuals, valuing their experience, and showing commitment to solving their health issues), and demonstrating competence (being knowledgeable, thorough, and solving their health issues). Trust in one's provider was highly correlated with all eight survey items measuring communication, caring, and competence. CONCLUSIONS To build trust with patients, health providers should actively listen, provide detailed explanations, show caring for patients, and demonstrate their knowledge.
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Affiliation(s)
- Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, 135 East 22nd St., Room 816D, New York, NY, 10010, USA.
| | - Christal Ramos
- Health Policy Center, The Urban Institute, 500 L'Enfant Plaza SW, Washington, DC, 20024, USA.
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Zghal A, El-Masri M, McMurphy S, Pfaff K. Exploring the Impact of Health Care Provider Cultural Competence on New Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers. J Transcult Nurs 2020; 32:508-517. [PMID: 33095098 PMCID: PMC8404719 DOI: 10.1177/1043659620967441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most. Methodology: Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment. Results: Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p < .001) and its psychological (β = −.318; p < .001), social (β = −.177; p = .048), and environmental (β = −.408; p < .001) domains. Discussion: Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners’ values and biases.
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Affiliation(s)
- Afef Zghal
- University of Windsor, Windsor, Ontario, Canada
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9
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Snyder M, Haskard-Zolnierek K, Howard K, Hu Y. Weight stigma is associated with provider-patient relationship factors and adherence for individuals with hypothyroidism. J Health Psychol 2020; 27:702-712. [PMID: 33081509 DOI: 10.1177/1359105320963548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The goal of this study was to examine weight stigma experiences during medical visits as related to provider-patient relationship factors and adherence among individuals with hypothyroidism. A total of 362 participants recruited via social media participated in an online survey. Regression and mediation analyses indicated that weight stigma was negatively associated with adherence; this relationship was mediated by decreased trust in provider, less perceived provider empathy, and lower provider-patient depth-of-relationship. Structural equation modeling with BMI controlled revealed that weight stigma is associated with worsened provider-patient relationship and adherence. Findings suggest the importance of eliminating weight stigma experiences for patients.
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Affiliation(s)
| | | | | | - Yueqin Hu
- Texas State University, San Marcos, TX, USA
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10
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McAlearney AS, Gregory M, Walker DM, Edwards M. Development and validation of an organizational readiness to change instrument focused on cultural competency. Health Serv Res 2020; 56:145-153. [PMID: 33025602 DOI: 10.1111/1475-6773.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To validate a brief survey developed to be used in hospitals nationwide to assess organizational readiness to change to increase cultural competency. DATA SOURCES/STUDY SETTING Analysis of primary data collected as part of a 125-item Organizational Assessment Survey conducted in the ten US hospitals participating in the Robert Wood Johnson Foundation Expecting Success program in 2005-2006. STUDY DESIGN The study utilized a cross-sectional survey. DATA COLLECTION Surveys were distributed to participants in the ten hospitals based on job title and role within the organization (including clinicians, clinical administrators, other clinical professionals, and those in relevant nonclinical roles; respondents = 513; response rate = 31%). Missing data were deleted listwise. We computed internal consistency reliability via Cronbach's alpha and interrater agreement using the rwg(j) index, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine validity of the survey. We subsequently conducted ANOVAs to examine whether the instrument adequately distinguished between hospitals. PRINCIPAL FINDINGS Across 408 complete responses, a scree plot generated by the EFA and a follow-up CFA indicated a 2-factor solution (RMSEA = 0.06; CFI = 0.96; GFI = 0.96; RMSR = 0.08). We identified these primary factors as two scales, a 12-item Readiness to Address Quality scale (α = 0.85; rwg(j) = 0.93) and an 11-item Readiness to Address Disparities scale (α = 0.65; rwg(j) = 0.89). ANOVAs suggested that these scales distinguished between hospitals (RTAQ: F[9, 428] = 3.70, P < .001; RTAD: F[9, 435] = 3.02, P = .002). CONCLUSIONS This survey can help identify an organization's readiness to change to increase cultural competency.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Megan Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Edwards
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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Duncan PW, Bushnell CD, Jones SB, Psioda MA, Gesell SB, D'Agostino RB, Sissine ME, Coleman SW, Johnson AM, Barton-Percival BF, Prvu-Bettger J, Calhoun AG, Cummings DM, Freburger JK, Halladay JR, Kucharska-Newton AM, Lundy-Lamm G, Lutz BJ, Mettam LH, Pastva AM, Xenakis JG, Ambrosius WT, Radman MD, Vetter B, Rosamond WD. Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006285. [PMID: 32475159 DOI: 10.1161/circoutcomes.119.006285] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objectives of this study were to develop and test in real-world clinical practice the effectiveness of a comprehensive postacute stroke transitional care (TC) management program. Methods and Results The COMPASS study (Comprehensive Post-Acute Stroke Services) was a pragmatic cluster-randomized trial where the hospital was the unit of randomization. The intervention (COMPASS-TC) was initiated at 20 hospitals, and 20 hospitals provided their usual care. Hospital staff enrolled 6024 adult stroke and transient ischemic attack patients discharged home between 2016 and 2018. COMPASS-TC was patient-centered and assessed social and functional determinates of health to inform individualized care plans. Ninety-day outcomes were evaluated by blinded telephone interviewers. The primary outcome was functional status (Stroke Impact Scale-16); secondary outcomes were mortality, disability, medication adherence, depression, cognition, self-rated health, fatigue, care satisfaction, home blood pressure monitoring, and falls. The primary analysis was intention to treat. Of intervention hospitals, 58% had uninterrupted intervention delivery. Thirty-five percent of patients at intervention hospitals attended a COMPASS clinic visit. The primary outcome was measured for 59% of patients and was not significantly influenced by the intervention. Mean Stroke Impact Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home blood pressure monitoring was self-reported by 72% of intervention patients versus 64% of usual care patients (adjusted odds ratio, 1.43 [95% CI, 1.21-1.70]). No other secondary outcomes differed. Conclusions Although designed according to the best available evidence with input from various stakeholders and consistent with Centers for Medicare and Medicaid Services TC policies, the COMPASS model of TC was not consistently incorporated into real-world health care. We found no significant effect of the intervention on functional status at 90 days post-discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.
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Affiliation(s)
- Pamela W Duncan
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Cheryl D Bushnell
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sara B Jones
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | - Matthew A Psioda
- Department of Biostatistics, Collaborative Studies Coordinating Center (M.A.P.), University of North Carolina at Chapel Hill
| | - Sabina B Gesell
- Social Sciences and Health Policy, Division of Public Health Sciences (S.B.G.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D'Agostino
- Division of Public Health Sciences, Department of Biostatistics and Data Science (R.B.D., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Mysha E Sissine
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sylvia W Coleman
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | | | | | - Adrienne G Calhoun
- Area Agency on Aging, Piedmont Triad Regional Council, Kernersville, NC (B.F.B.-P., A.G.C.)
| | - Doyle M Cummings
- Brody School of Medicine, East Carolina University, Greenville, NC (D.M.C.)
| | - Janet K Freburger
- Department of Physical Therapy School of Health and Rehabilitation Science, University of Pittsburgh, PA (J.K.F.)
| | - Jacqueline R Halladay
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (J.R.H.)
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | | | - Barbara J Lutz
- University of North Carolina at Wilmington School of Nursing (B.J.L.)
| | - Laurie H Mettam
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | - Amy M Pastva
- Duke University School of Medicine, Durham, NC (J.P.-B., A.M.P.)
| | - James G Xenakis
- Department of Biostatistics, Gillings School of Global Public Health (J.G.X.), University of North Carolina at Chapel Hill
| | - Walter T Ambrosius
- Division of Public Health Sciences, Department of Biostatistics and Data Science (R.B.D., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Meghan D Radman
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
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Raymond JK, Reid MW, Fox S, Garcia JF, Miller D, Bisno D, Fogel JL, Krishnan S, Pyatak EA. Adapting home telehealth group appointment model (CoYoT1 clinic) for a low SES, publicly insured, minority young adult population with type 1 diabetes. Contemp Clin Trials 2020; 88:105896. [DOI: 10.1016/j.cct.2019.105896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
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Denneson LM, Pisciotta M, Hooker ER, Trevino A, Dobscha SK. Impacts of a web-based educational program for veterans who read their mental health notes online. J Am Med Inform Assoc 2019; 26:3-8. [PMID: 30445648 DOI: 10.1093/jamia/ocy134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients' safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P < 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P < 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Amira Trevino
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Bull C, Byrnes J, Hettiarachchi R, Downes M. A systematic review of the validity and reliability of patient-reported experience measures. Health Serv Res 2019; 54:1023-1035. [PMID: 31218671 PMCID: PMC6736915 DOI: 10.1111/1475-6773.13187] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. DATA SOURCES/STUDY SETTING Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. PRINCIPAL FINDINGS Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. CONCLUSIONS Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
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Affiliation(s)
- Claudia Bull
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Joshua Byrnes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Ruvini Hettiarachchi
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Martin Downes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
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Quigley DD, Elliott MN, Hambarsoomian K, Wilson-Frederick SM, Lehrman WG, Agniel D, Ng JH, Goldstein EH, Giordano LA, Martino SC. Inpatient care experiences differ by preferred language within racial/ethnic groups. Health Serv Res 2019; 54 Suppl 1:263-274. [PMID: 30613960 PMCID: PMC6341216 DOI: 10.1111/1475-6773.13105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups. Data Source 2014‐2015 HCAHPS survey data. Study Design We compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within applicable subsets of five racial/ethnic groups (Hispanics, Asian/Pacific Islanders, American Indian/Alaska Natives, Blacks, and Whites). We measured patient‐mix adjusted overall, between‐ and within‐hospital differences in patient experience by language, using linear regression. Data Collection Methods Surveys from 5 480 308 patients discharged from 4517 hospitals 2014‐2015. Principal Findings Within each racial/ethnic group, mean reported experiences for non‐English‐preferring patients were almost always worse than their English‐preferring counterparts. Language differences were largest and most consistent for Care Coordination. Within‐hospital differences by language were often larger than between‐hospital differences and were largest for Care Coordination. Where between‐hospital differences existed, non‐English‐preferring patients usually attended hospitals whose average patient experience scores for all patients were lower than the average scores for the hospitals of their English‐preferring counterparts. Conclusions Efforts should be made to increase access to better hospitals for language minorities and improve care coordination and other facets of patient experience in hospitals with high proportions of non‐English‐preferring patients, focusing on cultural competence and language‐appropriate services.
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Affiliation(s)
| | | | | | | | | | | | - Judy H Ng
- National Committee for Quality Assurance, Washington, District of Columbia
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Assessing Patient Satisfaction Among Transgender Individuals Seeking Medical Services. Ann Plast Surg 2018; 81:725-729. [DOI: 10.1097/sap.0000000000001582] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, Wang H. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. J Adv Nurs 2018; 75:749-759. [DOI: 10.1111/jan.13854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Chulei Tang
- Xiangya School of Nursing Central South University ChangshaChina
| | | | - Xiaoxia Zhang
- Xiangya School of Nursing Central South University ChangshaChina
- Nursing Faculty Henan Medical College ZhengzhouChina
| | - Kaili Zhang
- Xiangya School of Nursing Central South University ChangshaChina
| | - Xueling Xiao
- Xiangya School of Nursing Central South University ChangshaChina
| | - Jane M. Simoni
- Department of Psychology University of Washington Seattle Washington
| | - Honghong Wang
- Xiangya School of Nursing Central South University ChangshaChina
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Ahmed S, Siad FM, Manalili K, Lorenzetti DL, Barbosa T, Lantion V, Lu M, Quan H, Santana MJ. How to measure cultural competence when evaluating patient-centred care: a scoping review. BMJ Open 2018; 8:e021525. [PMID: 30018098 PMCID: PMC6059336 DOI: 10.1136/bmjopen-2018-021525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to identify patient-centred quality indicators (PC-QI) and measures for measuring cultural competence in healthcare. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY A search of CINAHL, EMBASE, MEDLINE, PsycINFO, Social Work Abstracts and SocINDEX, and the grey literature was conducted to identify relevant studies. Studies were included if they reported indicators or measures for cultural competence. We differentiated PC-QIs from measures: PC-QIs were identified as a unit of measurement of the performance of the healthcare system, which reflects what matters to patients and families, and to any individual that is in contact with healthcare services. In contrast, measures evaluate delivery of patient-centred care, in the form of a survey and/or checklist. Data collected included publication year and type, country, ethnocultural groups and mention of quality indicator and/or measures for cultural competence. RESULTS The search yielded a total of 786 abstracts and sources, of which 16 were included in the review. Twelve out of 16 sources reported measures for cultural competence, for a total of 10 measures. Identified domains from the measures included: physical environment, staff awareness of attitudes and values, diversity training and communication. Two out of 16 sources reported PC-QIs for cultural competence (92 structure and process indicators, and 48 outcome indicators). There was greater representation of structure and process indicators and measures for cultural competence, compared with outcome indicators. CONCLUSION Monitoring and evaluating patient-centred care for ethnocultural communities allows for improvements to be made in the delivery of culturally competent healthcare. Future research should include development of PC-QIs for measuring cultural competence that also reflect cultural humility, and the involvement of ethnocultural communities in the development and implementation of these indicators.
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Affiliation(s)
- Sadia Ahmed
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fartoon M Siad
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Vic Lantion
- Ethno-Cultural Council of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Gordon EJ, Lee J, Kang RH, Caicedo JC, Holl JL, Ladner DP, Shumate MD. A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. BMC Health Serv Res 2018; 18:368. [PMID: 29769080 PMCID: PMC5956564 DOI: 10.1186/s12913-018-3151-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/25/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention. METHODS/DESIGN Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients. DISCUSSION Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time. TRIAL REGISTRATION (ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered).
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center for Healthcare Studies, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA.
| | - Jungwha Lee
- Preventive Medicine and Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Raymond H Kang
- Center for Healthcare Studies, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA
| | - Juan Carlos Caicedo
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA
| | - Jane L Holl
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA
| | - Daniela P Ladner
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA
| | - Michelle D Shumate
- Department of Communication Studies, Northwestern University, 240 Campus Drive, Rm 2-118, Evanston, IL, 60208, USA
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Use of Scribes for Documentation Assistance in Rheumatology and Endocrinology Clinics. J Clin Rheumatol 2018; 24:116-121. [DOI: 10.1097/rhu.0000000000000620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rine CM. Is Social Work Prepared for Diversity in Hospice and Palliative Care? HEALTH & SOCIAL WORK 2018; 43:41-50. [PMID: 29244119 DOI: 10.1093/hsw/hlx048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this article is to assess current and future trends in hospice and palliative care with the objective of informing culturally appropriate best practice for social work. Concern for the intersectionality of racial, ethnic, social, and other differences in end-of-life (EOL) care is imperative given the ever growing range of diversity characteristics among the increasing aging populations in the United States. A review of literature from the current decade that is pertinent to the profession contributes to the ability of social work to consider evidence and build agreement germane to EOL practice settings. Administrative reports, government data, academic literature, professional standards, and assessment tools contribute to the profession's ability to work toward cultural competence and develop practice strategies for EOL care. The varied roles held by social workers across health care arenas provide a unique opportunity to promote cultural competence and advance best practice on all levels of work.
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Affiliation(s)
- Christine M Rine
- Christine M. Rine, PhD, is assistant professor, Department of Social Work, Edinboro University of Pennsylvania, 235 Scotland Road, Hendricks Hall G-37, Edinboro, PA 16444; e-mail:
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Jongen C, McCalman J, Bainbridge R, Clifford A. Cultural Competence Strengths, Weaknesses and Future Directions. SPRINGERBRIEFS IN PUBLIC HEALTH 2018. [DOI: 10.1007/978-981-10-5293-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zelle BA, Singh G, Kitchen DL, Fajardo RJ, Bhandari M, Valerio MA. Ethnic differences in patients' perceptions towards isolated orthopedic injuries: a pilot study. Pilot Feasibility Stud 2017; 3:39. [PMID: 29142758 PMCID: PMC5674799 DOI: 10.1186/s40814-017-0188-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Patients' perceptions of their healthcare have been reported to influence clinical outcomes following orthopedic trauma. Findings across clinical outcomes have demonstrated significant differences in perceptions towards healthcare between Hispanics and non-Hispanic whites. However, ethnic disparities in perceptions towards orthopedic injuries have not been examined in the literature. Aim of study The aim of this pilot study is to explore whether Hispanic patients with isolated orthopedic injuries will demonstrate different perceptions towards their injury as compared to non-Hispanic white patients. The pilot data will be used to inform a subsequent larger clinical investigation and interventional study. Methods A total of 43 patients (31 Hispanics and 12 non-Hispanic whites) with isolated orthopedic injuries requiring surgical treatment were enrolled in this cross-sectional observational pilot study. Outcome measures included the Questionnaire of Perceived Injustice (QPI), Short-Form 36 Health Survey (SF-36v2), Pain Catastrophizing Scale, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence (CC) item set. Results The CAHPS was completed by 34 patients, and the remaining scoring systems were completed by all 43 subjects enrolled in this study. Hispanic patients trended towards higher QPI scores indicating poorer outcomes than non-Hispanic whites (mean difference [MD] 5.4, 95%; confidence interval [CI] - 4.4, 15.2). The mental component summary score of the SF-36 trended lower in Hispanics as compared to non-Hispanic white (MD - 6.8, 95%; CI - 15.0, 1.4). Hispanic patients also expressed less trust in their doctor on a scale from 0 to 10 (MD - 1.0, 95%; CI - 1.9, - 0.1). Conclusions Our study suggests ethnic differences in patients' perceptions towards isolated orthopedic injuries. These results must be interpreted cautiously given the limited number of subjects in this pilot examination. We collected sufficient data to allow a sample size calculation for a subsequent larger clinical investigation. Future clinical investigations may determine the influence of ethnic differences in patients' perceptions towards orthopedic injuries, identify their impact on the functional outcomes, and establish intervention strategies.
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Affiliation(s)
- Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA
| | - Gurpreet Singh
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA
| | - Deanna L Kitchen
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA
| | - Roberto J Fajardo
- Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX 78229 USA
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 2X2 Canada
| | - Melissa A Valerio
- UT Health School of Public Health, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 USA
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Lorch SA. Health Equity and Quality of Care Assessment: A Continuing Challenge. Pediatrics 2017; 140:peds.2017-2213. [PMID: 28847986 DOI: 10.1542/peds.2017-2213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Scott A Lorch
- Division of Neonatology, Department of Pediatrics and Center for Pediatric and Perinatal Health Disparities Research and Policy Lab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Leonard Davis Institute and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Quinn M, Robinson C, Forman J, Krein SL, Rosland AM. Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings: Available and Needed Measures. Med Care 2017; 55 Suppl 7 Suppl 1:S84-S91. [PMID: 28614185 DOI: 10.1097/mlr.0000000000000730] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improving access can increase the providers a patient sees, and cause coordination challenges. For initiatives that increase care across health care settings, measuring patient experiences with access and care coordination will be crucial. OBJECTIVES Map existing survey measures of patient experiences with access and care coordination expected to be relevant to patients accessing care across settings. Preliminarily examine whether aspects of access and care coordination important to patients are represented by existing measures. RESEARCH DESIGN Structured literature review of domains and existing survey measures related to access and care coordination across settings. Survey measures, and preliminary themes from semistructured interviews of 10 patients offered VA-purchased Community Care, were mapped to identified domains. RESULTS We identified 31 existing survey instruments with 279 items representing 6 access and 5 care coordination domains relevant to cross-system care. Domains frequently assessed by existing measures included follow-up coordination, primary care access, cross-setting coordination, and continuity. Preliminary issues identified in interviews, but not commonly assessed by existing measures included: (1) acceptability of distance to care site given patient's clinical situation; (2) burden on patients to access and coordinate care and billing; (3) provider familiarity with Veteran culture and VA processes. CONCLUSIONS Existing survey instruments assess many aspects of patient experiences with access and care coordination in cross-system care. Systems assessing cross-system care should consider whether patient surveys accurately reflect the level of patients' concerns with burden to access and coordinate care, and adequately reflect the impact of clinical severity and cultural familiarity on patient preferences.
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Affiliation(s)
- Martha Quinn
- *University of Michigan School of Public Health †VA Ann Arbor Center for Clinical Management Research, Health Services Research and Development ‡Department of Internal Medicine, Taubman Center, University of Michigan Medical School §University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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Nagarajan N, Rahman S, Boss EF. Are There Racial Disparities in Family-Reported Experiences of Care in Inpatient Pediatrics? Clin Pediatr (Phila) 2017; 56:619-626. [PMID: 27621079 DOI: 10.1177/0009922816668497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite increased emphasis on patient satisfaction as a quality measure in health care, little is known about the influence of race in parent-reported experience of care in pediatrics. This study evaluates the association of race with patient satisfaction scores in an inpatient pediatric tertiary care hospital in one year. Risk-adjusted multivariable logistic regression was performed to evaluate the association of minority race with the likelihood to provide a top-box (=5) satisfaction score for 38 individual questions across 8 domains. Of the 904 participants, 269 (29.8%) identified as belonging to a minority race. Parents of minority children reported 30% to 50% lower satisfaction across questions related to well-established themes of interpersonal communication and cultural competency. Overall, minorities also reported lower satisfaction for the domain of nursing care (odds ratio 0.7, P = .016). These findings suggest a need for training and interventions to improve communication and mitigate disparities in how minority patients and their families perceive pediatric care.
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Affiliation(s)
- Neeraja Nagarajan
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Brigham and Women's Hospital, Boston, MA, USA
| | - Sydur Rahman
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily F Boss
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, Gerger H. Trust in the health care professional and health outcome: A meta-analysis. PLoS One 2017; 12:e0170988. [PMID: 28170443 PMCID: PMC5295692 DOI: 10.1371/journal.pone.0170988] [Citation(s) in RCA: 374] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023] Open
Abstract
Objective To examine whether patients’ trust in the health care professional is associated with health outcomes. Study selection We searched 4 major electronic databases for studies that reported quantitative data on the association between trust in the health care professional and health outcome. We screened the full-texts of 400 publications and included 47 studies in our meta-analysis. Data extraction and data synthesis We conducted random effects meta-analyses and meta-regressions and calculated correlation coefficients with corresponding 95% confidence intervals. Two interdependent researchers assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results Overall, we found a small to moderate correlation between trust and health outcomes (r = 0.24, 95% CI: 0.19–0.29). Subgroup analyses revealed a moderate correlation between trust and self-rated subjective health outcomes (r = 0.30, 0.24–0.35). Correlations between trust and objective (r = -0.02, -0.08–0.03) as well as observer-rated outcomes (r = 0.10, -0.16–0.36) were non-significant. Exploratory analyses showed a large correlation between trust and patient satisfaction and somewhat smaller correlations with health behaviours, quality of life and symptom severity. Heterogeneity was small to moderate across the analyses. Conclusions From a clinical perspective, patients reported more beneficial health behaviours, less symptoms and higher quality of life and to be more satisfied with treatment when they had higher trust in their health care professional. There was evidence for upward bias in the summarized results. Prospective studies are required to deepen our understanding of the complex interplay between trust and health outcomes.
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Affiliation(s)
- Johanna Birkhäuer
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Jens Gaab
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Joe Kossowsky
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Placebo Studies and the Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sebastian Hasler
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Peter Krummenacher
- Collegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Christoph Werner
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Heike Gerger
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
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Sudore RL, Barnes DE, Le GM, Ramos R, Osua SJ, Richardson SA, Boscardin J, Schillinger D. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial. BMJ Open 2016; 6:e011705. [PMID: 27401363 PMCID: PMC4947727 DOI: 10.1136/bmjopen-2016-011705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/27/2016] [Accepted: 05/18/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours. METHODS AND ANALYSIS We include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression. ETHICS AND DISSEMINATION This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will be disseminated to academic and community stakeholders. TRIAL REGISTRATION NUMBERS NCT01990235; NCT02072941; Pre-results.
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Affiliation(s)
- Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA San Francisco Veterans Affairs Medical Center, San Francisco, California, USA Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA Departments of Epidemiology & Biostatistics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gem M Le
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Roberto Ramos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - Stacy J Osua
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sarah A Richardson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Northern California Institute for Research and Education, San Francisco, California, USA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA Departments of Epidemiology & Biostatistics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Dean Schillinger
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Department of Medicine, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Less Use of Extreme Response Options by Asians to Standardized Care Scenarios May Explain Some Racial/Ethnic Differences in CAHPS Scores. Med Care 2016; 54:38-44. [PMID: 26783857 DOI: 10.1097/mlr.0000000000000453] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asian Americans (hereafter "Asians") generally report worse experiences with care than non-Latino whites (hereafter "whites"), which may reflect differential use of response scales. Past studies indicate that Asians exhibit lower Extreme Response Tendency (ERT)-they less frequently use responses at extreme ends of the scale than whites. OBJECTIVE To explore whether lower ERT is observed for Asians than whites in response to standardized vignettes depicting patient experiences of care and whether ERT might in part explain Asians reporting worse care than whites. PROCEDURE A representative US sample (n=575 Asian; n=505 white) was presented with 5 written vignettes describing doctor-patient encounters with differing levels of physician responsiveness. Respondents evaluated the encounters using modified CAHPS communication questions. RESULTS Case-mix-adjusted repeated-measures multivariate models show that Asians provided more positive responses than whites to several vignettes with less-responsive physicians but less positive responses than whites for the vignette with the most physician responsiveness (P<0.01 for each). While all respondents provided more positive ratings for vignettes with greater physician responsiveness, the increase was 15% less for Asian than white respondents. CONCLUSIONS Asians exhibit lower ERT than whites in response to standardized scenarios. Because CAHPS reponses are predominantly near the positive end of the scale and the most responsive scenario is most typical of the score observed in real-world settings, lower ERT in Asians may partially explain observations of lower observed mean CAHPS scores for Asians in real-world settings. Case-mix adjustment for Asian race/ethnicity or its correlates may improve quality of care measurement.
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Sudore R, Le GM, McMahan R, McMahon R, Feuz M, Katen M, Barnes DE. The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial. Trials 2015; 16:570. [PMID: 26654250 PMCID: PMC4676815 DOI: 10.1186/s13063-015-1055-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Advance care planning (ACP) is a process whereby patients prepare for medical decision-making. The traditional objective of ACP has focused on the completion of advance directives. We have developed a new paradigm of ACP focused on preparing patients and their loved ones for communication and informed medical decision-making. To operationalize this new paradigm of ACP, we created an interactive, patient-centered website called PREPARE (www.prepareforyourcare.org) designed for diverse older adults. Methods/Design This randomized controlled trial with blinded outcome assessment is designed to determine the efficacy of PREPARE to engage older Veterans in the ACP process. Veterans who are ≥ 60 years of age, have ≥ two medical conditions, and have seen a primary care physician ≥ two times in the last year are being randomized to one of two study arms. The PREPARE study arm reviews the PREPARE website and an easy-to-read advance directive. The control arm only reviews the advance directive. The primary outcome is documentation of an advance directive and ACP discussions. Other clinically important outcomes using validated surveys include ACP behavior change process measures (knowledge, contemplation, self-efficacy, and readiness) and a full range of ACP action measures (identifying a surrogate, identifying values and goals, choosing leeway or flexibility for the surrogate, communicating with clinicians and surrogates, and documenting one’s wishes). We will also assess satisfaction with decision-making and Veteran activation within primary care visits by direct audio recording. To examine the outcomes at 1 week, 3 months, and 6 months between the two study arms, we will use mixed effects linear, Poisson, or negative binomial regression and mixed effects logistic regression. Discussion This study will determine whether PREPARE increases advance directive completion rates and engagement with the ACP process. If PREPARE is efficacious, it could prove to be an easy and effective intervention to help older adults engage in the ACP process within or outside of the medical environment. PREPARE may also help older adults communicate their medical wishes and goals to their loved ones and clinicians, improve medical decision-making, and ensure their wishes are honored over the life course. Trial registration ClinicalTrials.gov NCT01550731. Registered on 8 December 2011.
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Affiliation(s)
- Rebecca Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, 3333 California St. Suite 380, San Francisco, CA, 94143, USA. .,San Francisco Veterans Administration Medical Center, 4150 Clement Street, #151R, San Francisco, CA, 94121, USA.
| | - Gem M Le
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, 3333 California St. Suite 380, San Francisco, CA, 94143, USA. .,Division of General Internal Medicine, San Francisco General Hospital, Center for Vulnerable Populations, University of California, San Francisco, 2789 25th Street Suite 350, San Francisco, CA, 94110, USA.
| | - Ryan McMahan
- San Francisco Veterans Administration Medical Center, 4150 Clement Street, #151R, San Francisco, CA, 94121, USA.
| | - Ryan McMahon
- San Francisco Veterans Administration Medical Center, 4150 Clement Street, #151R, San Francisco, CA, 94121, USA.
| | - Mariko Feuz
- San Francisco Veterans Administration Medical Center, 4150 Clement Street, #151R, San Francisco, CA, 94121, USA.
| | - Mary Katen
- San Francisco Veterans Administration Medical Center, 4150 Clement Street, #151R, San Francisco, CA, 94121, USA.
| | - Deborah E Barnes
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, 3333 California St. Suite 380, San Francisco, CA, 94143, USA. .,Department of Psychiatry, University of California, San Francisco, CA, USA. .,Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
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Phillips NM, Street M, Haesler E. A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. BMJ Qual Saf 2015; 25:110-7. [PMID: 26415751 DOI: 10.1136/bmjqs-2015-004357] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/31/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.
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Affiliation(s)
- Nicole Margaret Phillips
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Emily Haesler
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Nieman CL, Benke JR, Boss EF. Does Race/Ethnicity or Socioeconomic Status Influence Patient Satisfaction in Pediatric Surgical Care? Otolaryngol Head Neck Surg 2015; 153:620-8. [PMID: 26124264 DOI: 10.1177/0194599815590592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction in outpatient pediatric surgical care and assess differences in scores by race/ethnicity and socioeconomic status (SES). STUDY DESIGN Observational, cross-sectional analysis. SETTING Outpatient pediatric surgical specialty clinics at a tertiary academic center. SUBJECT AND METHODS Families of patients received a patient satisfaction survey following their initial care visit in 2012. Mean scores were calculated and compared by child race/ethnicity and insurance type, where insurance with medical assistance (MA) served as a proxy for low SES. Kruskal-Wallis tests were used to compare scores between groups. Surveys were dichotomized to low and high scorers, and multivariate logistic regression was used to calculate the likelihood of high satisfaction. RESULTS Of 527 surveys completed, 132 (25%) were for children with MA and 143 (27%) were for racial/ethnic minority children. The overall satisfaction score for all specialties was 84.8, which did not significantly differ by SES (P = .98) or minority status (P = .52). The survey item with the highest score in both SES groups was "degree to which provider talked with you using words you could understand" (overall mean 91.94, P = .23). Multivariate analysis showed that patient age, sex, race/ethnicity, insurance type, neighborhood SES, neighborhood diversity, or surgical department did not significantly influence satisfaction. CONCLUSION This is the first study to evaluate the relationship between SES and race/ethnicity with patient satisfaction in outpatient pediatric surgical specialty care. In this analysis, no disparities were identified in the patient experience by individual- or community-level factors. Although the survey methodologies may be limited, these findings suggest that provision of care in pediatric surgical specialties can be simultaneously equitable, culturally competent, and family centered.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James R Benke
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Ward J, Humphries K, Coats J, Whitfield P. Attributes of Non-Hispanic Blacks That Use Chiropractic Health Care: A Survey of Patients in Texas and Louisiana. J Chiropr Med 2015; 14:15-23. [PMID: 26693213 DOI: 10.1016/j.jcm.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to describe non-Hispanic blacks that use chiropractic health care to better understand this underserved demographic. METHODS E-mail and telephone calls were used to recruit doctors of chiropractic (DCs) in Texas and Louisiana to distribute anonymous surveys to their non-Hispanic black patients. Twenty doctors volunteered to participate. Each was sent 10 surveys and self-addressed envelopes to distribute. All doctors were given at least 3 months to distribute surveys to as many non-Hispanic black patients that they had. The survey contained 20 questions designed to develop a profile of non-Hispanic black patients that used chiropractic care. Descriptive statistics were used to summarize demographic and other patient attributes. RESULTS Two-hundred surveys were distributed and 44 were completed, yielding a response rate of 22%. Non-Hispanic black patients were more likely to be female (54.5%), be older than 50 years (56.8%), be a college graduate (59.1%), be employed (61.9%), report not receiving public assistance in the past 5 years (81.4%), report a household income of $20 000 to $60 000 a year (48.8%), and born in the United States (83.7%). Participants reported that there was a DC within 30 minutes of their address (81.4%), their DC always explained things to them in an easy-to-understand manner (81.8%), their DC always showed respect for what they had to say (88.6%), and their DC always cared about them as a person (86.4%). CONCLUSIONS In the sample surveyed, non-Hispanic black patients tended to be female, be older, be college educated, be employed, and have a positive viewpoint on their interactions with their DC.
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Affiliation(s)
- John Ward
- Associate Professor/Research Fellow, Department of Physiology and Chemistry, Texas Chiropractic College, Pasadena, TX
| | | | - Jesse Coats
- Professor, Department of Clinical Specialties, Texas Chiropractic College, Pasadena, TX
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Price RA, Haviland AM, Hambarsoomian K, Dembosky JW, Gaillot S, Weech-Maldonado R, Williams MV, Elliott MN. Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract? Health Serv Res 2015; 50:1649-87. [PMID: 25752334 DOI: 10.1111/1475-6773.12292] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. DATA SOURCES/STUDY SETTING Exactly 492,495 Medicare beneficiaries responding to the 2008-2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. DATA COLLECTION/EXTRACTION METHODS Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. PRINCIPAL FINDINGS As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. CONCLUSIONS The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores.
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Affiliation(s)
| | | | | | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Müller E, Zill JM, Dirmaier J, Härter M, Scholl I. Assessment of trust in physician: a systematic review of measures. PLoS One 2014; 9:e106844. [PMID: 25208074 PMCID: PMC4160203 DOI: 10.1371/journal.pone.0106844] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/06/2014] [Indexed: 11/25/2022] Open
Abstract
Over the last decades, trust in physician has gained in importance. Studies have shown that trust in physician is associated with positive health behaviors in patients. However, the validity of empirical findings fundamentally depends on the quality of the measures in use. Our aim was to provide an overview of trust in physician measures and to evaluate the methodological quality of the psychometric studies and the quality of psychometric properties of identified measures. We conducted an electronic search in three databases (Medline, EMBASE and PsycInfo). The secondary search strategy included reference and citation tracking of included full texts and consultation of experts in the field. Retrieved records were screened independently by two reviewers. Full texts that reported on testing of psychometric properties of trust in physician measures were included in the review. Study characteristics and psychometric properties were extracted. We evaluated the quality of design, methods and reporting of studies with the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was assessed with Terwee's 2007 quality criteria. After screening 3284 records and assessing 169 full texts for eligibility, fourteen studies on seven trust in physician measures were included. Most of the studies were conducted in the USA and used English measures. All but one measure were generic. Sample sizes range from 25 to 1199 participants, recruited in very heterogeneous settings. Quality assessments revealed several flaws in the methodological quality of studies. COSMIN scores were mainly fair or poor. The overall quality of measures' psychometric properties was intermediate. Several trust in physician measures have been developed over the last years, but further psychometric evaluation of these measures is strongly recommended. The methodological quality of psychometric property studies could be improved by adhering to quality criteria like the COSMIN checklist.
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Affiliation(s)
- Evamaria Müller
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Jördis M. Zill
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
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Choi S. How Does Satisfaction With Medical Care Differ by Citizenship and Nativity Status?: A County-Level Multilevel Analysis. THE GERONTOLOGIST 2014; 55:735-47. [PMID: 24451897 DOI: 10.1093/geront/gnt201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/10/2013] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This study examined patient satisfaction among community-dwelling older adults by their citizenship and nativity statuses. Since the welfare reform of 1996, citizenship has been an important factor in determining health care access among foreign-born individuals. Little is known regarding how the perceived satisfaction of older noncitizens compares with that of U.S.-born and naturalized citizens and how it is affected by county-level contextual characteristics. DESIGN AND METHODS The 2000-2007 Medical Expenditure Panel Survey and linked Area Resource File were analyzed for 27,383 individuals (65+). Two dimensions of satisfaction (perceived access and ease of access) were examined using the Consumer Assessment of Health Plans Survey. Multilevel models were conducted using STATA. RESULTS After both individual- and county-level covariates were controlled for, noncitizens were less likely to agree that their providers had spent enough time with them (p = .03) or had sufficiently explained treatment (p = .01) compared with U.S.-born citizens. Noncitizens' overall ratings of their providers were also lower (p < .001). Among those reported needs, noncitizens reported greater difficulties in accessing acute care (p < .001), routine care (p < .001), and specialty care (p = .009). In these models, some county-level characteristics (e.g., % of foreign-born individuals) were negatively associated with individual-level satisfaction. Interestingly, noncitizens from counties with high densities of foreign-born populations had higher overall satisfaction levels than did their U.S.-born counterparts (i.e., interaction effect). IMPLICATIONS Guided by the expanded Andersen model, this study demonstrates the importance of considering both individual- and county-level contextual characteristics to accurately understand older noncitizens' access to health care and patient satisfaction.
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Affiliation(s)
- Sunha Choi
- College of Social Work, University of Tennessee, Knoxville.
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Risk factors for reporting poor cultural competency among patients with diabetes in safety net clinics. Med Care 2012; 50:S56-61. [PMID: 22895232 DOI: 10.1097/mlr.0b013e3182640adf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care. OBJECTIVE To determine characteristics of patients who identify the care they receive as less culturally competent. RESEARCH DESIGN Cross-sectional survey consisting of face-to-face interviews. SUBJECTS Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care. MEASURES Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities. RESULTS In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined. CONCLUSIONS Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.
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Abstract
BACKGROUND Prior studies have shown that racial/ethnic minorities have lower Consumer Assessments of Healthcare Providers and Systems (CAHPS) scores. Perceived discrimination may mediate the relationship between race/ethnicity and patient experiences with care. OBJECTIVE To examine the relationship between perceived discrimination based on race/ethnicity and Medicaid insurance and CAHPS reports and ratings of care. METHODS The study analyzed 2007 survey data from 1509 Florida Medicaid beneficiaries. CAHPS reports (getting needed care, timeliness of care, communication with doctor, and health plan customer service) and ratings (personal doctor, specialist care, overall health care, and health plan) of care were the primary outcome variables. Patient perceptions of discrimination based on their race/ethnicity and having Medicaid insurance were the primary independent variables. Regression analysis modeled the effect of perceptions of discrimination on CAHPS reports and ratings controlling for age, sex, education, self-rated health status, race/ethnicity, survey language, and fee-for-service enrollment. SEs were corrected for correlation within plans. RESULTS Medicaid beneficiaries reporting discrimination based on race/ethnicity had lower CAHPS scores, ranging from 15 points lower (on a 0-100 scale) for getting needed care to 6 points lower for specialist rating, compared with those who never experienced discrimination. Similar results were obtained for perceived discrimination based on Medicaid insurance. CONCLUSIONS Perceptions of discrimination based on race/ethnicity and Medicaid insurance are prevalent and are associated with substantially lower CAHPS reports and ratings of care. Practices must develop and implement strategies to reduce perceived discrimination among patients.
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Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population. Med Care 2012; 50:S49-55. [PMID: 22895231 DOI: 10.1097/mlr.0b013e31826410fb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. METHODS We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. RESULTS A 7-factor model demonstrated satisfactory fit (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. CONCLUSIONS Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.
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Does the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Survey provide equivalent measurement across English and Spanish versions? Med Care 2012; 50:S37-41. [PMID: 22895229 DOI: 10.1097/mlr.0b013e3182665189] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The English and Spanish versions of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey (CAHPS-CC) assess patients' experiences with culturally competent care. The possibility exists that even when Spanish and English speakers experience the same levels of culturally competent care, responses describing their care may differ. This is called measurement bias. To deliver reliable and valid information across language, responses must provide equivalent measurement across both versions. In this study, we examined whether measurement bias on the CAHPS-CC impedes valid measurement across the English and Spanish versions. METHODS We used multiple group (MG) confirmatory factor analyses (CFA) to examine measurement bias across English (n=851) and Spanish (n=113) speakers. Participants came from a 2008 sample of 2 Medicaid managed care plans in New York and California. RESULTS MG-CFA provided general support for the equivalence of the CAHPS-CC in measuring doctor communication-positive behaviors, doctor communication-negative behaviors, doctor communication-preventative care, equitable treatment, and trust. We did observe statistically significant differences in the thresholds associated with the item asking whether a doctor gave easier to understand instructions. However, analyses indicated that bias did not meaningfully influence conclusions about average experiences using the English and Spanish versions of the CAHPS-CC. CONCLUSIONS Our results support the use of the English and Spanish versions of the CAHPS-CC. Though we found some bias, analyses demonstrated that it did not substantively impact conclusions for the studied domains. Health providers can place confidence in the 2 different CAHPS-CC translations.
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Associations Between Aspects of Culturally Competent Care and Clinical Outcomes Among Patients With Diabetes. Med Care 2012; 50:S74-9. [DOI: 10.1097/mlr.0b013e3182641110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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