Patient assessment surveys have established a primary role in health care quality measurement as evidence has shown that information from patients can affect quality improvement for practitioners and lead to positivemarketwide changes. This article presents findings from the recently released National Healthcare Disparities Report revealing that although most clinical quality and access indicators show superior health care for non-Hispanic whites compared with blacks and Hispanics, blacks and Hispanics assess their interactions with providers more positively than non-Hispanic whites do. The article explores possible explanations for these racial/ethnic differences, including potential pitfalls in survey design that drawbiased responses by race/ethnicity. The article then suggests strategies for refining future research on racial/ethnic disparities based on patient assessment of health care.
Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine; 2002.
2.
Institute of Medicine. Guideline for the National Healthcare Disparities Report. Washington, DC: Institute of Medicine; 2002.
3.
Agency for Healthcare Research and Quality. National Healthcare Disparities Report. Rockville, Md: Agency for Healthcare Research and Quality; 2004.
4.
van Campen C, Sixma H, Friele RD, Kerssens JJ, Peters L.Quality of care and patient satisfaction: a review of measuring instruments. Med Care Res Rev. 1995;52:109-133.
Morales LS, Reise SP, Hays RD. Evaluating the equivalence of health care ratings by whites and Hispanics. Med Care. 2000;38:517-527.
7.
Murray-Garcia JL, Selby JV, Schittdiel J, Grumbach K, Quesebberry CP. Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300-310.
8.
Lurie N, Zhan C, Sangl J, Bierman AS, Sekscenski ES. Variation in racial and ethnic differences in consumer assessments of health care. Am J Manag Care. 2003;9:502-509.
9.
Morales LS, Elliott MN, Weech-Maldonado R, Spritzer KL, Hays RD. Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0. Health Serv Res. 2001;36:595-617.
10.
Weech-Maldonado R, Morales LS, Spritzer KL, Elliott MN, Hays RD. Racial and ethnic differences in patients' assessments of pediatric care in Medicaid managed care. Health Serv Res. 2001;36:575-594.
11.
Agency for Healthcare Research and Quality. National Healthcare Disparities Report Background. Rockville, Md: Agency for Healthcare Research and Quality; 2002.
12.
Hall JA, Doman MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: ameta-analysis. Soc Sci Med. 1990;30:811-818.
13.
Fox JG, Storms DM. A different approach to sociodemographic predictors of satisfaction with care. Soc Sci Med. 1981;15: 557-564.
14.
Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6:185-210.
15.
Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey (MEPS): overview of the MEPS Website. Available at: http://www.meps.ahrq.gov/.
16.
Medical Expenditure Panel Survey. A New National Health Information Resource. AHRQ Publication No. 00-P050. Rockville, Md: Agency for Healthcare Research and Quality; 2000.
17.
Tools for Research: Consumer Assessment of Health Plans (CAHPS). Rockville, Md: Agency for Healthcare Research and Quality; 2000. Available at: http://www.ahrq.gov/child/restools/trscahpsim.htm.
18.
Ellis BB, Kimmel HD. Identification of unique cultural response patterns by means of item response theory. J Appl Psychol. 1992;77:177-184.
19.
Woodard JL, Auchus AP, Godsall RE, Green RC. An analysis of text bias and differential item functioning due to race on the Mattis Dementia Rating Scale. J Gerontol. 1998;53B:370-374.
20.
Zaslavsky A, Zaborski L, Cleary P.Does the effect of respondent characteristics on consumer assessments vary across health plans?Med Care Res Rev. 2000;57:379-394.
21.
McHorney CA. Equating health status measures with item response theory. Med Care. 2000;38(9 suppl):II43-II59.
22.
Bachman JG, O'Malley PM. Yea-saying, nay-saying, and going to the extremes: black-white differences in response style. Public Opin Q. 1984;48:491-509.
23.
Aday LA, Chiu GY, Andersen R.Methodological issues in health care surveys of Spanish heritage population. Am J Public Health. 1980;70:367-374.
24.
Solberg LI, Beth Plane M, Brown RL, Underbakke G, McBride PE. Non-response bias: does it affect measurement of clinic behavior?Med Care. 2002;40:347-352.
25.
Zaslavsky AM, Zaborski LB, Cleary PD. Factors affecting response rates to the Consumer Assessment of Health Plans Survey. Med Care. 2002;40:485-499.
26.
Hayes RP, Baker DW. Methodological problems in comparing English-speaking and Spanish-speaking patients' satisfaction with interpersonal aspects of care. Med Care. 1998;36:230-236.
27.
Hui C, Triandis HC. Effects of culture and response format on extremeresponse style. JCross Cult Psychol. 1989;20:296-309.
28.
Reise SP, Widaman KF, Pugh RH. Confirmatory factor analysis and item response theory: two approaches for exploring measurement invariance. Psychol Bull. 1993;114:552-566.
29.
Ware JE Jr, Bjorner JB, Kosinski M.Practical implications of item response theory and computerized adaptive testing: a brief summary of ongoing studies of widely used headache impact scales. Med Care. 2000;38(9 suppl):II73-II82.
30.
Hays RD, Morales LS, Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care. 2000;38(9 suppl):II28-II42.
31.
Hambleton R, Swaminathan H, Rogers HJ. Fundamentals of Item Response Theory. Newbury Park, CA: Sage; 1991.
32.
Huang CD, Church AT, Katigbak MS. Identifying cultural differences in items and traits: differential items functioning in the NEO personality inventory. J Cross Cult Psychol. 1997;28: 192-218.
33.
Thompson A, Sunol R.Expectations as determinants of patient satisfaction: concepts, theory, and evidence. Int J Qual Health Care. 1995;7:127-141.
34.
Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271:690-694.
35.
Holden C.Secrets of happiness. Science. 2001;293:45-45.
36.
Sitzia J, Wood N.Patient satisfaction: a review of issues and concepts. Soc Sci Med. 1997;45:1829-1843.
37.
Kravitz RL, Cope DW, Bhrany V, Leake B.Internal medicine patients' expectation for care during office visits. J Gen Intern Med. 1994;9:75-81.
38.
Zemencuk JK, Feightner JW, Hayward RA, Skarupski KA, Katz SJ. Patients' desires and expectations for medical care in primary care clinics. J Gen Intern Med. 1998;13:273-276.
39.
Kravitz RL. Patients' expectations for medical care: an expanded formulation based on a review of the literature. Med Care Res Rev. 1996;53:3-27.
40.
Evans G.Political ideology and popular beliefs about class and opportunity: evidence from a survey experiment. Br J Sociol. 1997;48:450-470.
41.
Valentine N, Lavallee R, Liu B, Bonsel GJ, Murray CJL. Classical psychometric assessment of the responsiveness instrument in the WHO multi-country survey of health and responsiveness. Available at: http://whqlibdoc.who.int/publications/2003/9241562455.pdf.
42.
Peck BM, Asch DA, Goold SD, et al. Measuring patient expectations: does the instrument affect satisfaction or expectations?Med Care. 2001;39:100-108.
43.
Stolte JF. The context of satisfying in vignettes research. J Soc Psychol. 1994;134:727-731.
44.
Weinick RM, Zuvekas SH, Cohen JW. Racial and ethnic differences in access to and use of health care services: 1977 and 1996. Med Care Res Rev. 2000;57(suppl 1):36-54.
45.
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40:52-59.
46.
Longo DR, Land G, Schramm W, Fraas J, Hoskins B, Howell V.Consumer reports in health care: do they make a difference in patient care?JAMA. 1997;278:1579-1584.
47.
Hibbard JH, Harris-Kojetin L, Mullin P, Lubalin J, Garfinkel S.Increasing the impact of health plan report cards by addressing consumer concerns. Health Aff. 2000;19:138-143.
