title: Examining multiple sources of differential item functioning on the Clinician & Group CAHPS® survey.
abstract: OBJECTIVE
  To evaluate psychometric properties of a widely used patient experience survey.
  
  
  METHODS
  English-language responses to the Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS®) survey (n = 12,244) from a 2008 quality improvement initiative involving eight southern California medical groups.
  
  
  METHODS
  We used an iterative hybrid ordinal logistic regression/item response theory differential item functioning (DIF) algorithm to identify items with DIF related to patient sociodemographic characteristics, duration of the physician-patient relationship, number of physician visits, and self-rated physical and mental health. We accounted for all sources of DIF and determined its cumulative impact.
  
  
  RESULTS
  The upper end of the CG-CAHPS® performance range is measured with low precision. With sensitive settings, some items were found to have DIF. However, overall DIF impact was negligible, as 0.14 percent of participants had salient DIF impact. Latinos who spoke predominantly English at home had the highest prevalence of salient DIF impact at 0.26 percent.
  
  
  CONCLUSIONS
  The CG-CAHPS® functions similarly across commercially insured respondents from diverse backgrounds. Consequently, previously documented racial and ethnic group differences likely reflect true differences rather than measurement bias. The impact of low precision at the upper end of the scale should be clarified.
authors.affiliation: Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095, USA. hrod@ucla.edu
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
mesh_terms: D000328:Adult; D000367:Age Factors; D000465:Algorithms; D015992:Body Mass Index; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011594:Psychometrics; D044469:Racial Groups; D012737:Sex Factors; D011795:Surveys and Questionnaires
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