Can hospital cultural competency reduce disparities in patient experiences with care?
BACKGROUND
Cultural competency has been espoused as an organizational strategy to reduce health disparities in care.


OBJECTIVE
To examine the relationship between hospital cultural competency and inpatient experiences with care.


METHODS
The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital's cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients.


METHODS
The National CAHPS Benchmarking Database's (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006.


METHODS
Dependent variables include 10 HCAHPS measures: 6 composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), 2 individual items (cleanliness and quietness of patient rooms), and 2 global items (overall hospital rating, and whether patient would recommend hospital).


RESULTS
Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on 4 other dimensions: nurse communication, staff responsiveness, quiet room, and pain control.


CONCLUSIONS
Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement.
Department of Health Services Administration, University of Alabama at Birmingham, AL 35294, USA. rweech@uab.edu
Robert
R
Weech-Maldonado
Marc
M
Elliott
Rohit
R
Pradhan
Cameron
C
Schiller
Allyson
A
Hall
Ron D
RD
Hays
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002140:California; D054521:Cultural Competency; D019538:Health Care Surveys / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D055815:Young Adult