Zhu Junya, Weingart Saul N, Ritter Grant A, Tompkins Christopher P, Garnick Deborah W
*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD †Tufts Medical Center, Boston ‡The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
Med Care. 2015 May;53(5):446-54. doi: 10.1097/MLR.0000000000000350.
An important aspect of medical care is clear and effective communication, which can be particularly challenging for individuals based on race/ethnicity. Quality of communication is measured systematically in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and analyzed frequently such as in the National Healthcare Disparities Report. Caution is needed to discern differences in communication quality from racial/ethnic differences in perceptions about concepts or expectations about their fulfillment.
To examine assumptions about the degree of commonality across racial/ethnic groups in their perceptions and expectations, and to investigate the validity of conclusions regarding racial/ethnic differences in communication quality.
We used 2007 HCAHPS data from the National CAHPS Benchmarking Database to construct racial/ethnic samples that controlled for other patient characteristics (828 per group). Using multiple-groups confirmatory factor analyses, we tested whether the factor structure and model parameters (ie, factor loadings, intercepts) differed across groups.
We identified support for basic tests of equivalence across 7 racial/ethnic groups in terms of equivalent factor structure and loadings. Even stronger support was found for Communication with Doctors and Nurses. However, potentially important nonequivalence was found for Communication about Medicines, including instances of statistically significant differences between non-Hispanic whites and non-Hispanic blacks, Asians, and Native Hawaiian/other Pacific Islanders.
Our results provide strongest support for racial/ethnic comparisons on Communication with Nurses and Doctors, and reason to caution against comparisons on Communication about Medicines due to significant differences in model parameters across groups; that is, a lack of invariance in the intercept.
医疗护理的一个重要方面是清晰有效的沟通，而对于基于种族/民族的个体而言，这可能极具挑战性。沟通质量在《医院医疗服务提供者与系统消费者评估》（HCAHPS）调查中得到系统衡量，并经常在诸如《国家医疗保健差异报告》中进行分析。需要谨慎区分沟通质量的差异与种族/民族在概念认知或对其实现的期望方面的差异。
检验关于种族/民族群体在认知和期望方面的共性程度的假设，并调查关于沟通质量的种族/民族差异结论的有效性。
我们使用了来自国家CAHPS基准数据库的2007年HCAHPS数据，构建了控制其他患者特征的种族/民族样本（每组828个）。使用多组验证性因素分析，我们测试了因素结构和模型参数（即因素负荷、截距）在不同群体之间是否存在差异。
我们发现有证据支持在7个种族/民族群体之间进行等效性的基本测试，包括等效的因素结构和负荷。在与医生和护士的沟通方面，得到了更强有力的支持。然而，在关于药物的沟通方面发现了潜在的重要非等效性，包括非西班牙裔白人与非西班牙裔黑人、亚洲人以及夏威夷原住民/其他太平洋岛民之间存在统计学显著差异的情况。
我们的结果为在与护士和医生的沟通方面进行种族/民族比较提供了最有力的支持，同时也有理由因不同群体之间模型参数存在显著差异（即截距缺乏不变性）而对关于药物沟通的比较持谨慎态度。
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