title: Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items between Whites and Asians.
abstract: Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. We examined responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items by Whites and Asians, controlling for underlying level on the CAHPS constructs.
  
  
  
  We conducted multiple group analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled data from 2007 to 2011. Responses were obtained from 1,326,410 non-Hispanic Whites and 40,672 non-Hispanic Asians (hereafter referred to as Whites and Asians). The median age for Whites was 70, with 24 % 80 or older, and 70 for Asians, with 23 % 80 or older. Fifty-eight percent of Whites and 56 % of Asians were female.
  
  
  
  A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates (7 factor loadings, 3 measured variable errors, and 2 item intercepts): Comparative Fit Index = 0.947 and 0.948; root-mean-square error of approximation = 0.052 and 0.052, respectively). Differences in latent CAHPS score means between Whites and Hispanics estimated from the two models were similar, differing by 0.053 SD or less.
  
  
  
  This study provides support for measurement equivalence of the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparisons of care experiences between the two groups.
authors: Division of General Internal Medicine & Health Services Research, Center for Maximizing Outcomes and Research on Effectiveness (C-MORE), UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024, USA. drhays@g.ucla.edu.
authors: Ron D
authors: RD
authors: Hays
authors: Kaiser Permanente Division of Research, Oakland, CA, USA.
authors: Neetu
authors: N
authors: Chawla
authors: National Cancer Institute, Rockville, MD, USA.
authors: Erin E
authors: EE
authors: Kent
authors: Patient-Centered Outcomes Research Institute, Washington, DC, USA.
authors: Neeraj K
authors: NK
authors: Arora
mesh_terms: D000293:Adolescent; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D011788:Quality of Life / Q000523:psychology*; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
keywords: Asians; CAHPS; Measurement equivalence; Patient evaluations of health care