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What Matters Most to Whom: Racial, Ethnic, and Language Differences in the Health Care Experiences Most Important to Patients

Collins, Rebecca L. PhD*; Haas, Ann MS, MPH; Haviland, Amelia M. PhD†,‡; Elliott, Marc N. PhD*

doi: 10.1097/MLR.0000000000000804
Original Articles

Background: Some aspects of patient experience are more strongly related to overall ratings of care than others, reflecting their importance to patients. However, little is known about whether the importance of different aspects of this experience differs across subgroups.

Objectives: To determine whether the aspects of health care most important to patients differ according to patient race, ethnicity, and language preference.

Research Design: In response to the 2013 Medicare Consumer Assessment of Health Plans Study (CAHPS) survey, patients rated their overall health care and completed items measuring five patient experience domains. We estimated a linear regression model to assess associations between overall rating of care and the 5 domains, testing for differences in these relationships for race/ethnicity/language groups, controlling for covariates.

Subjects: In total 242,782 Medicare beneficiaries, age 65 years or older.

Measures: Overall rating of health care, composite patient experience scores for: doctor communication, getting needed care, getting care quickly, customer service, and care coordination.

Results: A joint test of the interactions between the composite scores and the 5 largest racial/ethnic/language subgroups was statistically significant (P <0.0001), suggesting the importance of domains varied across subgroups. Doctor communication had the strongest relationship with care ratings for non-Hispanic whites and English-preferring Hispanics. Getting needed care had the strongest relationship for Spanish-preferring Hispanics and Asian/Pacific Islanders. Doctor communication and getting care quickly were strongest for African Americans.

Conclusions: Tailoring quality improvement programs to the factors most important to the racial, ethnic, and language mix of the patient population of the practice, hospital, or plan may more efficiently reduce disparities and improve quality.

*RAND Corporation, Santa Monica, CA

RAND Corporation

Carnegie Mellon University, H. John Heinz College of Public Policy and Management, Pittsburgh, PA

Supported by Centers for Medicare & Medicaid Services under contract number GS-10F-0275P / HHSM-500-2014-00399G to RAND Corporation.

The authors declare no conflict of interest.

Reprints: Marc N. Elliott, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401. E-mail:

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