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Abstract
BackgroundDifferences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance.MethodsWe evaluated the three-factor structure and the equivalence of responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinical and Group (CG-CAHPS) Adult Visit Survey 1.0 and compared care experiences of Asians and Whites. Thirteen questions were used to elicit reports about specific aspects of care and two questions assessed overall care perceptions.This analysis of the CAHPS database included 769 providers and 266,327 respondents. Most surveys (98%) were administered by mail and the rest (2%) by phone. Only 0.5% of the surveys were administered in Spanish. The sample was 64% female, 89% White and 2% Asian, 39% 65 years or older, and 32% were high school graduates or less.ResultsA three-factor model was supported by categorical confirmatory factor analysis using weighted least squares with mean and variance adjustment: confirmatory fit index (CFI) = 0.99 and root mean squared error of approximation (RMSEA) = 0.03). A multi-group configural invariance model also fit the data well: (CFI = 0.993, RMSEA = 0.031). Regression models indicated that Asians reported worse access, lower scores on office staff courtesy and helpfulness and rating their doctors and were less likely to recommend their doctors to family/friends than did Whites.ConclusionsUse of the CG-CAHPS Adult Visit Survey 1.0 to assess perceptions of care by Asians and Whites is supported. Quality improvement efforts are needed to address worse experiences of care among Asians in the United States.
Highlights
Differences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance
Snyder and colleagues [5] found that Asian Americans reported worst self-reported access to care than all racial/ethnic groups
Morales et al [8] analyzed Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan 1.0 survey data collected from 54 commercial and 34 Medicaid health plans and found that most minorities reported experiences like non-Hispanic Whites, except for Asian Americans, who expressed worse perceptions of care
Summary
Differences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance. Snyder and colleagues [5] found that Asian Americans reported worst self-reported access to care (wait times, reaching the doctor’s office via phone) than all racial/ethnic groups. Morales et al [8] analyzed Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan 1.0 survey data collected from 54 commercial and 34 Medicaid health plans and found that most minorities reported experiences like non-Hispanic Whites, except for Asian Americans, who expressed worse perceptions of care. Weech-Maldonado and colleagues [9] found that racial/ethnic minorities fared worse than non-Hispanic Whites on the CAHPS Health Plan 2.0 survey. Several other studies have confirmed worse experiences with care for Asian Americans [10, 11]
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