title: Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?
abstract: OBJECTIVE
  To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans.
  
  
  METHODS
  5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data.
  
  
  METHODS
  Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures.
  
  
  RESULTS
  Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/.21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API.
  
  
  CONCLUSIONS
  Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures.
authors.affiliation: Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: Center for Effectiveness and Research, Kaiser Permanente, Pasadena, CA.
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.affiliation: H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA.
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Haviland
authors.affiliation: Department of Pediatrics, Boston Children's Hospital, Boston, MA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hambarsoomian
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Carol
authors.initials: C
authors.lastname: Edwards
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Jacob W
authors.initials: JW
authors.lastname: Dembosky
authors.affiliation: Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gaillot
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D019985:Benchmarking / Q000706:statistics & numerical data; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000706:statistics & numerical data*; D008603:Mental Health; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: CAHPS; HEDIS; Medicare; disparities; race/ethnicity