247966 Accommodating the many facets of difference: Patient assessments of providers' sensitivity to culture and other factors impacting the quality of clinical services in a large, diverse Medicaid health plan

Tuesday, November 1, 2011: 9:10 AM

S. Rae Starr, MPhil, MOrgBehav , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Nai Kasick, MPH, CHES , Health Education, Cultural and Linguistic Services, L.A. Care Health Plan, Los Angeles, CA
Lenna Monte, MPH , CHES , Cultural and Linguistic Services, L.A. Care Health Plan, Los Angeles, CA
Leticia Segura, MHA , Provider Network Operations, L.A. Care Health Plan, Los Angeles, CA
Gwen Cathey , Provider Network Operations, L.A. Care Health Plan, Los Angeles, CA
Accommodating differences is a key component in developing the quality of communication and doctor-patient rapport necessary for accurate diagnosis and delivery of clinically-appropriate care by the physician. This rapport is particularly necessary as health care increasingly addresses health issues where member adherence is a key part of successful treatment -- and where guidelines now probe private topics, choices and behaviors that intersect with culture.

(1) Medicaid as a bellwether population: The need for culturally-competent care is particularly crucial among Medicaid patients, who increasingly come from diverse cultures, and who lack resources to locate and purchase services from providers attuned to their needs.

(2) Setting for study: This presentation reports CAHPS survey findings from a large urban Medicaid health plan (pooled 2008-2010), using supplemental questions that ask patients what kinds of sensitivity training they feel their providers need.

(3) Patients' assessments of doctors' cultural competence: The chances of providers successfully getting information and cooperation from patients are improved if the provider has a functional understanding of how to accommodate the many facets of difference that may impair a clinical encounter. What differences do members notice most as areas where providers need training on working with differences? Patients might not always notice or fully understand when a cultural competency barrier is present in a clinical encounter with a physician. Nevertheless, the patient is a first-hand witness at the place-of-service, and the patient's judgment is an important yardstick for assessing doctors' cultural competence and its impact on clinical services.

(4) Analyses: The briefing summarizes member responses on the (a) the relative prevalence of patients mentioning cultural competency training needed by providers, in relation to 9 other categories of difference; (b) the proportion of members who report provider insensitivities on culture, and on other facets of difference (age, gender, disability, etc.); (c) differences in the issues reported by adult patients versus parents of pediatric patients; (d) the patient's assessment that a provider needed cultural sensitivity training will be analyzed to explore the degree to which that flaw is associated with the patient's rating of the provider, and the patient's rating of the quality of communication with the provider.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Describe patient-reported prevalence of cultural insensitivity among urban Medicaid providers. 2. Contrast the prevalence of cultural sensitivity problems for adults versus pediatric patients. 3. Assess impact of cultural sensitivity problems on patient ratings of the quality of ambulatory care and services. 4. Discuss the comparative rank of cultural sensitivity versus other categories of difference (age, gender, disability, income, etc.) that impact doctor/patient communication.

Keywords: Cultural Competency, Barriers to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Experience: Six years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2011, including all facets of the survey to be discussed in the presentation. Worked collaboratively with staff in culture, linguistics, and health promotion departments on design of survey questions for CAHPS and group needs assessment surveys, to gather patient feedback on providers' cultural competence, and the willingness of staff to accommodate cultural differences, language differences, and other barriers to receiving health care services. Setting: L.A. Care Health Plan is a public entity serving Los Angeles County, California, and the largest public health insurer in the United States. L.A. Care's CAHPS survey represents voice for approximately 850,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. The challenges addressed at L.A. Care likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly. Education: Master of Philosophy in Policy Analysis from the RAND Graduate School of Policy Analysis (Santa Monica CA); Master of Organizational Behavior from Brigham Young University (Provo, UT); Bachelor of Political Science with Honors from Brigham Young University (Provo UT).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.