Assessing Patient Experiences with Healthcare in Multi-Cultural Settings.

摘要

This dissertation examines patient experiences with healthcare in multi-cultural settings. The first three chapters present a theoretical conceptualization of patient satisfaction, a general framework for producing culturally appropriate survey instruments, and an assessment of the readability level of the Consumer Assessments of Health Plans Study (CAHPS(Registered)) 2.0 surveys. The results of the readability assessment, which are based on readability formulas, show that both the Spanish and English versions of the CAHPS(Registered) 2.0 survey instruments require approximately a seventh grade reading ability. The next three chapters present results from empirical studies examining racial/ethnic differences in reports and ratings of care. The first study is based on 7,093 patient surveys collected in English and in Spanish for the United Medical Group Association (UMGA) study and examines differences among Hispanics responding in Spanish, Hispanics responding in English, and non- Hispanics whites responding in English in ratings of communication by doctors. After controlling for age and gender, Hispanics responding in Spanish rated communication by their doctors lower than Hispanics responding in English (p < 0.05) and non-Hispanics whites responding in English (p < 0.05). The next two studies are based on the National CAHPS(Registered) Benchmarking Database (NCBD) 1.0. The NCBD 1.0 contains 28,354 completed adult and 9,870 child CAHPS(Registered) 1.0 surveys from 118 health plans across the United States. Reports about access to care, promptness of care, communication by doctors, the courtesy and helpfulness of doctor's office staff, health plan customer service, and global ratings of doctors (both personal doctors and specialists), healthcare and health plans were examined for racial/ethnic differences. After controlling for age, gender, education, and health status, significant differences were found among the racial/ethnic groups examined.