UCLA

Racial/ethnic disparities in patient experiences are widely reported. Asian Americans (Asians) consistently report worse care experiences in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys than non-Hispanic whites (Whites). However, little is known whether these race/ethnic differences in reports and ratings are due to differences in care experiences or differential response tendencies.

This dissertation consists of three studies. The first study compares reports and ratings of care between Asians and Whites using ordinary least squares analyses. The second study evaluates whether the hypothesized factor structure underlying the scoring of the CAHPS survey is confirmed in the survey dataset using categorical confirmatory factor analytic models. The third paper evaluates measurement invariance between Asians and Whites using a multiple group confirmatory factor analysis. The dissertation uses the Clinician & Group CAHPS Adult Visit Surveys 1.0 data collected in 2011.

In the first study, Asians reported worse care experiences on access to care, office staff courtesy and helpfulness, rated their doctor lower and were less likely to recommend their doctor to family and friends than Whites. On physician communication, no significant difference was noted between Asians and Whites. The reported differences in care experiences between Asians and Whites are likely due to real racial/ethnic differences in care received rather than lack of measurement invariance. The study findings have several important policy implications and provide directions for future research. Quality improvement initiatives in primary care need to be tailored towards reducing racial/ethnic differences in care. Further research will be needed to understand what are the underlying reasons for differential care for Asians and Whites in ambulatory care.