Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement...

Area of Science:

• Health Services Research
• Health Disparities
• Patient Experience

Background:

• Effective communication is crucial in healthcare, yet racial/ethnic disparities can impact its quality.
• The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey systematically measures communication quality.
• Distinguishing true communication quality differences from variations in perceptions and expectations across racial/ethnic groups is essential.

Purpose of the Study:

• To evaluate the commonality of perceptions and expectations regarding healthcare communication across diverse racial/ethnic groups.
• To assess the validity of conclusions drawn about racial/ethnic differences in communication quality.

Main Methods:

• Utilized 2007 HCAHPS data from the National CAHPS Benchmarking Database.
• Constructed balanced racial/ethnic samples, controlling for other patient characteristics (n=828 per group).
• Employed multiple-groups confirmatory factor analyses to test for differences in factor structure and model parameters across groups.

Main Results:

• Found support for measurement equivalence across seven racial/ethnic groups regarding factor structure and loadings.
• Stronger evidence of equivalence was observed for "Communication with Doctors and Nurses."
• Identified significant non-equivalence in "Communication about Medicines" between non-Hispanic whites and other racial/ethnic groups (Blacks, Asians, Native Hawaiian/other Pacific Islanders).

Conclusions:

• Racial/ethnic comparisons are most valid for "Communication with Nurses and Doctors."
• Caution is advised when comparing "Communication about Medicines" across racial/ethnic groups due to statistically significant differences in model parameters (intercept non-invariance).
• Findings highlight the need for nuanced analysis of patient communication experiences by race/ethnicity.