Organizational and Market Characteristics Associated with Hospital's Adherence to the CLAS Standards

Cultural competence has been defined as an “ongoing commitment or institutionalization of appropriate practices and policies for diverse populations” (Brach and Fraser, 2000). The national standards for culturally and linguistically appropriate services (CLAS) in health care, set forth by the Department of Health and Human Services' Office of Minority Health, provide guidelines on policies and practices aimed at developing culturally competent systems of care. The Cultural Competency Assessment Tool for Hospitals (CCATH) is a survey instrument used to assess hospital's performance based on the CLAS standards. The purpose of this study is to examine the organizational and market characteristics associated with hospital's adherence to 14 CLAS standards.

Data consist of 2006 CCATH survey data, Hospital Inpatient Discharges, American Hospital Association Annual Survey, and the Area Resource File for acute care hospitals in California. The dependent variable is adherence to the CLAS standards, which represents the proportion of the 14 CLAS standards that are being practiced by the hospital. The independent variables include organizational and market variables hypothesized to be associated with CLAS adherence. Organizational characteristics include proportion of racial/ethnic minority patients in the hospital, size (total inpatient days for the year), teaching hospital status, health system membership, ownership status (government, not-for-profit, for-profit), and payer mix (proportion of Medicaid patients). Market characteristics include hospital competition and the proportion of racial/ethnic minorities in the service area. We will regress the hospital's adherence to CLAS standards to organizational and market variables.