Objective. To examine the predictors of unit and item nonresponse, the magnitude of nonresponse bias, and the need for nonresponse weights in the Consumer Assessment of Health Care Providers and Systems (CAHPS s ) Hospital Survey. Methods. A common set of 11 administrative variables (41 degrees of freedom) was used to predict unit nonresponse and the rate of item nonresponse in multivariate models. Descriptive statistics were used to examine the impact of nonresponse on CAHPS Hospital Survey ratings and reports. Results. Unit nonresponse was highest for younger patients and patients other than non-Hispanic whites ( po.001); item nonresponse increased steadily with age ( po.001). Fourteen of 20 reports of ratings of care had significant ( po.05) but small negative correlations with nonresponse weights (median À 0.06; maximum À 0.09). Nonresponse weights do not improve overall precision below sample sizes of 300-1,000, and are unlikely to improve the precision of hospital comparisons. In some contexts, casemix adjustment eliminates most observed nonresponse bias. Conclusions. Nonresponse weights should not be used for between-hospital comparisons of the CAHPS Hospital Survey, but may make small contributions to overall estimates or demographic comparisons, especially in the absence of case-mix adjustment.
Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions. Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity. Principal Findings. Responses to both language versions exhibit similar patterns with respect to item-scale correlations, factor structure, content validity, and the association between each of the seven qualities of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish-language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions. The goal of this article is to compare the measurement properties of the Spanish and English versions of the H-CAHPS survey. We precede the psychometric analysis with a brief description of the procedures used for the survey translation and cultural adaptation, including a summary of the results of the cognitive interviews used to test the conceptual equivalence of the Spanish version of the H-CAHPS survey that preceded the field test. Unlike some other studies that examine the measurement properties of a translated survey instrument subsequent to and independently from the original version, in this article we simultaneously assess and compare the measurement properties of the source English version with the translated Spanish version. METHODS Development of the Spanish Version of the CAHPS Hospital Survey for the Pilot StudyThe Spanish translation and cultural adaptation of the original English-language H-CAHPS survey was conducted following an initial set of procedures established by the CAHPS cultural comparability team. First, a professional translator translated the questionnaire from English to Spanish. Second, another independent professional translator, blinded to the original source questionnaire, was provided with the Spanish translated version and asked to back-translate it into English. Third, a professional translation reviewer examined the products of the two translation...
ABSTRACT:The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system. They describe the practical and methodological challenges faced by health plans exploring the business and social cases for undertaking disparity-reducing interventions. Despite these challenges, sound business and quality improvement principles can guide health care organizations seeking to reduce disparities. Place-based interventions may help focus resources and engage health care and community partners who can share in the costs of-and gains from-such efforts.
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