Commentary on Patient-Provider Communication Quality, 2002–2016

Abstract

I t has been over 2 decades since the US Department of Health and Human Service implemented the National Standards for culturally and Linguistically Appropriate Services (CLAS) standards 1 to emphasize on engaging culturally and linguistically appropriate patientprovider communication as a strategy to improve access to health care and reduce health disparities was introduced. 2,3 Culturally and linguistically appropriate services are vital to improving the quality of health services provided to all individuals, specifically those who have limited English proficiency (LEP). Quality health care and patient outcomes rely upon being able to communicate with providers, especially in a patient's preferred language. 4 This requires having access to health care and quality languages services for patients with LEP in the health care setting as directed in Title VI of the Civil Rights Act of 1964. 5 Yet, studies consistently show that Asian Americans continuously report worse health care experiences than any other racial and ethnic groups in the United States. 6 Cho and Chang's 7 study recognized the importance of including understudied Asian patients as a separate subgroup in the data compared with other races and ethnicities. Their study findings are consistent with racial/ethnic disparities in patient experiences, specifically Asian Americans' low-quality patient-provider communication in health care settings. Researchers have suggested that this experience could be attributed to language barriers, cultural nuances, and/or Asians' tendency to select options at the extreme ends of a response scale. 8,9 In this commentary, the authors attempt to address the following questions: "Why do Asian patients continuously have the lowest quality of patient-provider communication over time?" and "What needs to be considered when examining the rating of patientprovider communication in Asian patients?" WHY DO ASIAN PATIENTS CONTINUOUSLY HAVE THE LOWEST QUALITY OF PATIENT-PROVIDER COMMUNICATION OVER TIME?Asian Americans' sociodemographic characteristics alone, such as education, income, and health care access, do not sufficiently explain the health disparities they experience compared with other racial/ethnic groups. 10,11 Existing studies of Asian Americans have either lumped them into a single group labeled "Asian Americans and Pacific Islanders," collapsed into the category of "Other," or excluded Asians as a racial group altogether. Thus, little or no accurate population-based data on Asian and Pacific Islander subgroups exist to identify their unique health problems. 10,11 It is important to recognize that Asian American and Pacific Islanders encompass > 50 ethnic subgroups that speak > 100 dialects with a wide range of cultures, traditions, identities, and experiences; thus, aggregating health data of Asian Americans mask meaningful differences in Asian American subgroups. 10,11 Although there are existing studies that compare the differences among American and Pacific Islanders, there are marked differences in sociodemographic...