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Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items between Whites and Asians

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Abstract

Purpose

Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. We examined responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items by Whites and Asians, controlling for underlying level on the CAHPS constructs.

Methods

We conducted multiple group analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled data from 2007 to 2011. Responses were obtained from 1,326,410 non-Hispanic Whites and 40,672 non-Hispanic Asians (hereafter referred to as Whites and Asians). The median age for Whites was 70, with 24 % 80 or older, and 70 for Asians, with 23 % 80 or older. Fifty-eight percent of Whites and 56 % of Asians were female.

Results

A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates (7 factor loadings, 3 measured variable errors, and 2 item intercepts): Comparative Fit Index = 0.947 and 0.948; root-mean-square error of approximation = 0.052 and 0.052, respectively). Differences in latent CAHPS score means between Whites and Hispanics estimated from the two models were similar, differing by 0.053 SD or less.

Conclusions

This study provides support for measurement equivalence of the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparisons of care experiences between the two groups.

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Acknowledgments

The authors would like to thank Karen L. Spritzer for her input, and we acknowledge use of data from the SEER-CAHPS data linkage resource, funded by a National Cancer Institute contract (HHSN261201000166U). Dr. Hays was supported by grants from the NIA (P30-AG021684) and the NIMHD (P20-MD000182). The opinions expressed in the manuscript are those of the authors and do not necessarily reflect the study sponsors or their institutional affiliations.

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Authors and Affiliations

  1. Division of General Internal Medicine & Health Services Research, Center for Maximizing Outcomes and Research on Effectiveness (C-MORE), UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024, USA

    Ron D. Hays

  2. Kaiser Permanente Division of Research, Oakland, CA, USA

    Neetu Chawla

  3. National Cancer Institute, Rockville, MD, USA

    Erin E. Kent

  4. Patient-Centered Outcomes Research Institute, Washington, DC, USA

    Neeraj K. Arora

Authors
  1. Ron D. Hays
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  2. Neetu Chawla
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  3. Erin E. Kent
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  4. Neeraj K. Arora
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Corresponding author

Correspondence to Ron D. Hays.

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All authors declare no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants.

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Hays, R.D., Chawla, N., Kent, E.E. et al. Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items between Whites and Asians. Qual Life Res 26, 311–318 (2017). https://doi.org/10.1007/s11136-016-1383-6

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  • DOI: https://doi.org/10.1007/s11136-016-1383-6

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