Thinking CAHPS: Using patient surveys to correlate providers' cultural competence with patients' health literacy, 2008-2010

Health care in the U.S. increasingly focuses on conditions where outcomes rely on the doctor's ability to avoid cultural and other missteps to cultivate the patient as a literate partner in care. For conditions such as hypertension, obesity, asthma, diabetes, etc, many treatments are patient-administered, and success depends on patients' adherence to guidelines about checkups, medications, diet, etc. In multicultural populations, such as those served by Medicaid, providers' cultural competency is particularly important.

(1) Linking patient adherence to providers' persuasiveness: Several HEDIS measures of clinical quality in effect measure health plans on enrolled doctors' ability to persuade members to adhere to medical guidance regarding checkups, vaccinations, etc.

(2) Assessing providers' cultural competence: This presentation will use data from a large and diverse Medicaid health plan. Supplemental questions were added to CAHPS (2008-2010), to gauge patients' assessments of their providers' need for cultural competence training.

(3) Assessing patients' health literacy: Respondents were also asked to mark reasons why they did not seek age-appropriate checkups. The reasons included choices reflecting patients' misconceptions about health risks, and response options which reflect patients' divergence from clinicians' assessments about the benefits and importance of well-care visits.

(4) Measuring the association between providers' cultural competence and patients' health literacy: Patients who exhibit either good or poor health literacy regarding the purpose of well-care visits, are tabulated against patients who indicated their providers either needed cultural competency training, or had no such need. The briefing will report the degree of association between the two variables -- discussing whether patient adherence improves from provider cultural competence, and whether its lack harms patient adherence.

(5) Analyses: The study explores whether other factors also mediated the association between the presence or absence of cultural sensitivity in the provider and patients' health literacy. Despite modest sample sizes, coarse breakdowns were employed to explore additional questions: (a) Does the propensity to report that a provider needs cultural competency training, differ by ethnicity or language group? (b) Is the association of cultural insensitivity on patient health literacy different for adult patients or pediatric patients? (c) Given that culture often interacts with gender, does the association between cultural insensitivity on patient health literacy, differ by patient gender? (d) How often do cultural sensitivity issues arise in patients' own words in verbatim comments about ways to improve the quality of health care services?