Ahmedov Mohir, Pourat Nadereh, Liu Honghu, Hays Ron D
Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA.
Center for Health Policy Research, University of California, Los Angeles, California, USA.
J Patient Rep Outcomes. 2021 Mar 24;5(1):29. doi: 10.1186/s41687-021-00303-3.
Differences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance.
We 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.
A 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.
Use 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.
与非西班牙裔白人（白人）相比，亚裔美国人（亚洲人）报告的护理体验差异可能是由于缺乏测量不变性。
我们评估了三因素结构以及对医疗服务提供者和系统消费者评估（CAHPS®）临床与团体（CG-CAHPS）成人就诊调查1.0的反应等效性，并比较了亚洲人和白人的护理体验。使用13个问题来获取关于护理特定方面的报告，另外两个问题评估总体护理感知。对CAHPS数据库的这项分析包括769个医疗服务提供者和266,327名受访者。大多数调查（98%）通过邮寄方式进行，其余（2%）通过电话进行。只有0.5%的调查用西班牙语进行。样本中64%为女性，89%为白人，2%为亚洲人，39%年龄在65岁及以上，32%为高中毕业生或学历更低。
使用均值和方差调整的加权最小二乘法进行分类验证性因素分析支持了三因素模型：验证性拟合指数（CFI）=0.99，近似均方根误差（RMSEA）=0.03）。多组构型不变性模型也很好地拟合了数据：（CFI = 0.993，RMSEA = 0.031）。回归模型表明，与白人相比，亚洲人报告的就医便利性较差，在办公室工作人员礼貌和帮助程度方面得分较低，对医生的评价也较低，并且不太可能向家人/朋友推荐自己的医生。
支持使用CG-CAHPS成人就诊调查1.0来评估亚洲人和白人的护理感知。需要进行质量改进努力，以解决美国亚洲人较差的护理体验问题。
