Does Hospital's Adherence to the CLAS Standards Influence Diverse Patients' Experiences with Inpatient Care

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 relationship of hospital's adherence to CLAS standards and racial/ethnic disparities in patient experiences with inpatient care.

Data consist of 2006 CCATH Survey data and California Hospital Assessment and Reporting Taskforce (CHART) Patient Experience Survey data for acute care hospitals in California. The dependent variables are the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital Survey reports and an overall rating of inpatient care. Reports of care include patient assessments of their communication with doctors and nurses, staff responsiveness, pain control, among others. The independent variables consist of hospital's adherence to the CLAS standards (proportion of the 14 CLAS standards practiced by the hospital) and patient characteristics (race/ethnicity, primary language, education, self-rated health, type of admission, and length of stay). We also include interaction terms of race/ethnicity with adherence to the CLAS standards. Mixed models using Proc Mixed will be estimated where hospital's adherence to CLAS is considered a random effect and patient characteristics are fixed effects. We will compare models with and without the CLAS adherence scores to determine the amount of variance accounted by this variable.