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Ethnicity and Language Differences in Patient Experience: an Analysis of the HCAHPS Survey

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Although there has been a rising emphasis on patient-centered care, limited research has assessed differences in patient experience based on ethnicity and language.

Methods

This study examined differences in quality of care (N = 6945) using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Data were collected between January 2014 and April 2019. Bivariate and multivariate analyses assessed relationships between ethnicity/language with individual items capturing specific components of care and global hospital evaluations using regression modeling.

Results

Compared to English-speaking non-Hispanic White patients, Spanish-speaking Hispanic/Latinx patients reported more positive interactions with nurses, physicians, and the hospital environment and reported a better understanding of care after discharge. Findings also indicated that Spanish-speaking Hispanic/Latinx patients were more satisfied with their experience compared to non-Hispanic White patients.

Discussion

Spanish-speaking Hispanic/Latinx patients were more satisfied with specific components of care and also scored higher in a measure of the global patient experience. Findings suggest the need for setting clear expectations for health care encounters and adapting health system responses to better capture factors driving Hispanic/Latinx patient satisfaction.

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Availability of Data and Material

Data are from The University of California Irvine Medical Center Records and the Hospital Consumer Assessment of Healthcare Providers and Systems.

Code Availability

The authors created and used a custom code.

Notes

  1. Analyses were also conducted using listwise deletion without imputation. Results exhibited a similar pattern of results.

References

  1. O’Connor A, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR, et al. Toward the “tipping point”: decision aids and informed patient choice. Health Aff. 2007;26(3):716–25. https://doi.org/10.1377/hlthaff.26.3.716.

    Article  Google Scholar 

  2. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.

    Article  Google Scholar 

  3. Centers for Medicare and Meicaid Services. Hospital consumer assessment of healthcare providers and systems: patients’ perspectives of care survey. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS. Accessed April 15th 2020.

  4. Figueroa JF, Zheng J, Orav EJ, Jha AK. Across US hospitals, black patients report comparable or better experiences than white patients. Health Aff. 2016;35(8):1391–8.

    Article  Google Scholar 

  5. Figueroa JF, Reimold KE, Zheng J, Orav EJ. Differences in patient experience between Hispanic and Non-Hispanic White patients across U.S. hospitals. J Healthc Qual. 2018;40(5):292–300.

    Article  Google Scholar 

  6. U.S. Census Bureau. Facts for Features: 2018 Hispanic Heritage Month. 2018. https://www.census.gov/newsroom/facts-for-features/2018/hispanic-heritage-month.html. Accessed May 2019.

  7. U.S. Census Bureau. 2017 national population projections. https://www.census.gov/programs-surveys/popproj.html. Accessed April 10th 2020.

  8. Hollingshead NA, Ashburn-Nardo L, Stewart JC, Hirsh AT. The pain experience of Hispanic Americans: a critical literature review and conceptual model. J Pain. 2016;17(5):513–28.

    Article  Google Scholar 

  9. Rhoades JA. The uninsured in America 1996-2004: estimates for the civilian noninstitutionalized population under age 65. statistical brief #84. Rockville, MD: Agency for Healthcare Research and Quality. 2005.

  10. O’hara B, Caswell K. Health status, health insurance, and medical services utilization: 2010. Curr Pop Rep. 2012;2012:70–133.

    Google Scholar 

  11. Weech-Maldonado R, Morales LS, Spritzer K, Elliott M, Hays RD. Racial and ethnic differences in parents’ assessments of pediatric care in Medicaid managed care. Health Serv Res. 2001;36(3):575–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Fortier MA, Martin SR, Kain DI, Tan ET. Parental attitudes regarding analgesic use for children: differences in ethnicity and language. J Pediatr Surg. 2011;46(11):2140–5.

    Article  Google Scholar 

  13. Elliott MN, Haviland AM, Kanouse DE, Hambarsoomian K, Hays RD. Adjusting for subgroup differences in extreme response tendency in ratings of health care: impact on disparity estimates. Health Serv Res. 2009;44(2p1):542–61.

    Article  Google Scholar 

  14. Cefalu M, Elliott MN, Hays RD. Adjustment of patient experience surveys for how people respond. Med Care. 2021;59(3):202–5.

    Article  Google Scholar 

  15. Elliott MN, Lehrman WG, Beckett MK, Goldstein E, Hambarsoomian K, Giordano LA. Gender differences in patients’ perceptions of inpatient care. Health Serv Res. 2012;47(4):1482–501.

    Article  Google Scholar 

  16. Woods SE, Bivins R, Oteng K, Engel A. The influence of ethnicity on patient satisfaction. Ethn Health. 2007;10:235–42.

    Article  Google Scholar 

  17. Barr DD. Race/ethnicity and patient satisfaction: using the appropriate method to test for perceived differences in care. J Gen Intern Med. 2004;19(9):937–43.

    Article  Google Scholar 

  18. Johnson RL, Roter D, Power NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.

    Article  Google Scholar 

  19. Goldstein E, Elliott MN, Lehrman WG, Hambarsoomian K, Giordano LA. Racial/ethnic differences in patients’ perceptions of inpatient care using the HCAHPS survey. Med Care Res Rev. 2010;67(1):74–92.

    Article  Google Scholar 

  20. Weech-Maldonado R, Fongwa MN, Gutierrez P, Hays RD. Language and regional differences in evaluations of medicare managed care by Hispanics. Health Serv Res. 2008;43(2):552–68.

  21. Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid assessments of care in Medicaid managed care. Health Serv Res. 2003;38(3):789–808.

    Article  Google Scholar 

  22. Quigley DD, Elliott MN, Hambarsoomian K, Wilson-Frederick SM, Lehrman WG, Agniel D, et al. Inpatient care experiences differ by preferred language within racial/ethnic groups. Health Serv Res. 2019;54:263–74.

    Article  Google Scholar 

  23. Weech-Maldonado R, Elliott MN, Oluwole A, Schiller KC, Hays RD. Survey response style and differential use of CAHPS rating scales by Hispanics. Med Care. 2008;46(9):963–8.

    Article  Google Scholar 

  24. Menendez ME, Loeffler M, Ring D. Patient satisfaction in an outpatient hand surgery office: a comparison of English-and Spanish-speaking patients. Qual Manag Health Care. 2015;24(4):183–9.

    Article  Google Scholar 

  25. Ponce NA, Hays RD, Cunningham WE. Linguistic disparities in health care access and health status among older adults. J Gen Intern Med. 2006;21(7):786–91.

    Article  Google Scholar 

  26. O’Brien M, Shea J. Disparities in patient satisfaction among Hispanics: the role of language preference. J Immigr Minor Health. 2011;13(2):408–12.

    Article  Google Scholar 

  27. Ruiz JM, Hamann HA, Mehl MR, O’Connor M-F. The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. Group Processes & Intergroup Relations. 2016:19(4):462–476.

  28. Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101(3):253–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Franzini L, Fernandez-Esquer ME. Socioeconomic, cultural, and personal influences on health outcomes in low income Mexican-origin individuals in Texas. Soc Sci Med. 2004;59(8):1629–46.

    Article  Google Scholar 

  30. Gordon EJ, Caicedo JC. Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work? Nephrol Dial Transplant. 2009;24(4):1103–9. https://doi.org/10.1093/ndt/gfn691.

    Article  PubMed  Google Scholar 

  31. Hargraves JL, Hays RD, Cleary PD. Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. Health Serv Res. 2003;38(6):1509–27. https://doi.org/10.1111/j.1475-6773.2003.00190.x.

    Article  PubMed  Google Scholar 

  32. Presson AP, Zhang C, Abtahi AM, Kean J, Hung M, Tyser AR. Psychometric properties of the Press Ganey® Outpatient Medical Practice Survey. Health Qual Life Outcomes. 2017;15(1). https://doi.org/10.1186/s12955-017-0610-3.

  33. Hospital Consumer Assessment of Healthcare Providers and Systems. CAHPS hospital survey. https://www.hcahpsonline.org/en/summary-analyses/. Accessed April 15th 2020.

  34. Ehwerhemuepha L, Feaster W, Kain Z. Impact of anesthesiologists on parental perioperative satisfaction scores. Pediatr Anesth. 2017;27(9):949–54.

    Article  Google Scholar 

  35. Ehwerhemuepha L, Schultz S, Feaster W. Clinical and psychosocial factors associated with patient experience in pediatrics. Clin Pediatr. 2018;57(8):937–44. https://doi.org/10.1177/0009922817737078.

    Article  Google Scholar 

  36. Zhang Z. Multiple imputation with multivariate imputation by chained equation (MICE) package. Ann Transl Med. 2016;4(2):30–35.

  37. Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput. 2010;39(4):860–4.

    Article  Google Scholar 

  38. Elliott MN, Cohea CW, Lehrman WG, Goldstein EH, Cleary PD, Giordano LA, et al. Accelerating improvement and narrowing gaps: trends in patients’ experiences with hospital care reflected in HCAHPS public reporting. Health Serv Res. 2015;50(6):1850–67.

    Article  Google Scholar 

  39. Weech-Maldonado R, Elliott MN, Pradhan R, Schiller C, Hall A, Hays RD. Can hospital cultural competency reduce disparities in patient experiences with care? Med Care. 2012;50:S48–55.

    Article  Google Scholar 

  40. Kravitz RL. Patients’ expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev. 1996;53(1):3–27.

    Article  CAS  Google Scholar 

  41. Berhane A, Enquselassie F. Patient expectations and their satisfaction in the context of public hospitals. Patient Prefer Adherence. 2016;10:1919–28.

    Article  Google Scholar 

  42. Curtin R, Presser S, Singer E. The effects of response rate changes on the index of consumer sentiment. Public Opin Q. 2000;64:413–28.

    Article  CAS  Google Scholar 

  43. Moore DL, Tarnai J. Evaluating nonresponse error in mail surveys In: Groves RM, Dillman DA, Eltinge JL, Little RJAL, editors. Survery Nonresponse. Wiley; 2001.

  44. Green KE. Sociodemographic factors and mail survey response. Psychol Mark. 1996;13(2):171–84.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA

    Candice D. Donaldson

  2. Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA

    Candice D. Donaldson, Archana Bharadwaj, Michelle A. Fortier & Zeev N. Kain

  3. Central Michigan University College of Medicine, Mount Pleasant, MI, USA

    Archana Bharadwaj

  4. UC Irvine Health, Orange, CA, USA

    Bradley Giafaglione & Pat Patton

  5. Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA

    Michelle A. Fortier

  6. Department of Pediatric Psychology, CHOC Children’s, Orange, CA, USA

    Michelle A. Fortier

  7. Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA

    Michelle A. Fortier & Zeev N. Kain

  8. Department of Psychological Science, University of California, Irvine, CA, USA

    Zeev N. Kain

  9. Yale Child Study Center, Yale University, New Haven, CT, USA

    Zeev N. Kain

  10. Health Policy Research Institution, University of California, Irvine, CA, USA

    Michelle A. Fortier

  11. Department of Pediatrics, CHOC Children’s, Orange, CA, USA

    Zeev N. Kain

Authors
  1. Candice D. Donaldson
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  2. Archana Bharadwaj
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  3. Bradley Giafaglione
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Corresponding author

Correspondence to Zeev N. Kain.

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Ethics Approval

The protocol was reviewed by an Institutional Review Board, which concluded this study was exempt and does not qualify as human subject research.

Conflict of Interest

Dr. Zeev Kain serves as a speaker for Edwards Lifesciences, Covidien, and Huron Consulting, and is the President of the American College of Perioperative Medicine. All other authors have no conflicts of interest to report.

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Donaldson, C.D., Bharadwaj, A., Giafaglione, B. et al. Ethnicity and Language Differences in Patient Experience: an Analysis of the HCAHPS Survey. J. Racial and Ethnic Health Disparities 9, 899–908 (2022). https://doi.org/10.1007/s40615-021-01029-0

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  • DOI: https://doi.org/10.1007/s40615-021-01029-0

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