Differences by race, ethnicity, and language in key drivers of health care experiences

Research suggests that doctor communication is highly related to patients’ overall ratings of health care. However, little is known about how the aspects of care most important to patients may differ across sub-populations. We examined the extent to which the domains of patient experience most associated with overall ratings of healthcare vary by race/ethnicity and language. Using 2013 Medicare CAHPS data, we estimated a linear regression model to predict overall rating of healthcare from five domains of patient experience: doctor communication, getting needed care, getting care quickly, customer service, and care coordination. The model also included indicators for race/ethnicity and language, race/ethnicity/language by experience-composite interaction terms, standard CAHPS case-mix adjusters, Medicare Advantage (MA) contract (treating-fee-for-service as one level), and Hospital Referral Region.

We found substantial differences across racial/ethnic/language subgroups in the relative importance of the five patient experience domains. A joint test of the interactions between the composite scores and the five largest racial/ethnic/language subgroups was statistically significant (p < .0001), suggesting that the importance of these domains of patient experience varied across subgroups. There was evidence of heterogeneous associations across groups for three composites: doctor communication (p=0.001), getting care quickly (p=0.0084), and care coordination (p=0.0089).

The relative importance of the five domains was similar for non-Hispanic Whites and English-preferring Hispanics, with doctor communication being the best predictor of healthcare rating for both groups. Doctor communication was less strongly related to healthcare rating for Spanish-preferring Hispanics, African Americans, and Asian/Pacific Islanders than for non-Hispanic Whites. Doctor communication was still the best predictor of healthcare ratings for African-Americans, but for Spanish-preferring Hispanics or Asian/Pacific Islanders, for whom getting needed care was the most important predictor of healthcare rating. For Asian/Pacific Islanders getting care quickly was less predictive of healthcare ratings than for non-Hispanic Whites. Care coordination more strongly predicted healthcare ratings for African Americans than for non-Hispanic Whites.

Our findings indicate that the aspects of patient experience that underlie ratings of healthcare vary across racial, ethnic, and language sub-populations. The differences we observed in the associations between different composite measures and overall care ratings may reflect cultural differences in beliefs or expectations regarding these different aspects of care. Our findings suggest a need to tailor quality improvement interventions based on the patient population of the practice, hospital, or plan.