title: Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors?
abstract: BACKGROUND
  An important aspect of medical care is clear and effective communication, which can be particularly challenging for individuals based on race/ethnicity. Quality of communication is measured systematically in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and analyzed frequently such as in the National Healthcare Disparities Report. Caution is needed to discern differences in communication quality from racial/ethnic differences in perceptions about concepts or expectations about their fulfillment.
  
  
  OBJECTIVE
  To examine assumptions about the degree of commonality across racial/ethnic groups in their perceptions and expectations, and to investigate the validity of conclusions regarding racial/ethnic differences in communication quality.
  
  
  METHODS
  We used 2007 HCAHPS data from the National CAHPS Benchmarking Database to construct racial/ethnic samples that controlled for other patient characteristics (828 per group). Using multiple-groups confirmatory factor analyses, we tested whether the factor structure and model parameters (ie, factor loadings, intercepts) differed across groups.
  
  
  RESULTS
  We identified support for basic tests of equivalence across 7 racial/ethnic groups in terms of equivalent factor structure and loadings. Even stronger support was found for Communication with Doctors and Nurses. However, potentially important nonequivalence was found for Communication about Medicines, including instances of statistically significant differences between non-Hispanic whites and non-Hispanic blacks, Asians, and Native Hawaiian/other Pacific Islanders.
  
  
  CONCLUSIONS
  Our results provide strongest support for racial/ethnic comparisons on Communication with Nurses and Doctors, and reason to caution against comparisons on Communication about Medicines due to significant differences in model parameters across groups; that is, a lack of invariance in the intercept.
authors: *Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD †Tufts Medical Center, Boston ‡The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
authors: Junya
authors: J
authors: Zhu
authors: Saul N
authors: SN
authors: Weingart
authors: Grant A
authors: GA
authors: Ritter
authors: Christopher P
authors: CP
authors: Tompkins
authors: Deborah W
authors: DW
authors: Garnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005006:Ethnicity / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010351:Patient Discharge; D010465:Perception; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult