Racial/ethnic differences in reporting versus rating of healthcare experiences

Abstract

Asians are reported to have poorer healthcare experience than non-Hispanic Whites (NHWs), but the sources of the differences are not understood. One explanation is Asian's reluctance to choose extreme responses in survey. We thus sought to compare NHW-Asian differences in responses to healthcare experience surveys when asked to report versus rate their experiences. Patients of an outpatient care system in 2013 to 2014 in the United States were studied. Patient experience surveys were sent after randomly selected clinic visits. Responses from 6 major Asian subgroups and NHWs were included (N = 61,115). The surveys used a combined questionnaire of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Press Ganey surveys. CG-CAHPS questions are framed as “reporting” and Press Ganey questions as “rating” of experiences. We compared the proportion of favorable (or top box) responses to 2 related questions, one from CG-CAHPS and another from Press Ganey, and assessed racial/ethnic differences when using each of the 2 related questions, using a Pearson chi-squared test for independence. All Asian subgroups were less likely to select top box than NHWs for all questions. The Asian-NHW differences in "rating” questions were larger than the difference in related “reporting” questions. Of those who chose top box to CG-CAHPS questions (e.g., “Yes” on a question asking “Waited < 15 minutes”), their responses to related Press Ganey questions varied widely: 47% to 57% of Asian subgroups versus 67% of NHWs rated wait time as “Very good.” The extent of racial/ethnic differences in patient-reported experiences varies based on how questions are framed. The observed poorer experiences by Asians are in part explained by their worse rating of similar objectively measurable experiences.

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

“…Since this study was limited by the participants recruited from a medical center in Taiwan, the generalization could be limited to the geographic area. Moreover, the Consumer Assessment of Healthcare Providers and Systems and the Press Ganey Medical Practice Survey revealed that Asian patients reported lower healthcare experience ratings than did Caucasian patients (Chung, Mujal, Liang, Palaniappan, & Frosch, 2018; Liao et al, 2020). Indeed, the cultural background of the participants concerning their illness and perception play an essential factor in the administration of health care.…”

The Relationship Between Primary Care Physician Burnout and Patient-Reported Care Experiences: a Cross-sectional Study

“…The magnitude of the relationship was modest (0.43 percentage point per each level in burnout scale) in part due to the ceiling effect in patient experience surveys. As variation in patient experience scores across organizations is known to be very small 23,53,54 and the variation across providers within an organization can be even smaller, the effect size observed here can be considered meaningful. Although the trends were in the same direction, the effects on access and the overall rating of the physician, after controlling for PCP workload, were not significant.…”

“…Response rates ranged from 15 to 20%, typical of patient experience surveys sent without financial incentives or reminders. 21,22 While response rates vary by patient demographics, e.g., older and non-Hispanic white individuals are more likely to respond, [23][24][25][26][27] potential bias due to low response rate at provider level, after adjusting…”

“…Scores were adjusted for patient characteristics including age, gender, race/ethnicity, and English proficiency, which are known to be associated with response patterns independent of patient experience itself. 23,28 While patient experience survey response rates are low, typically 15-30%, 29 and can be positively biased (as patients with better experience are more likely to respond), there is no reason we are aware of to believe potential bias would be systematically different across PCPs, after taking into account relevant respondent demographic characteristics.…”

Patient Satisfaction Surveys in the Outpatient Clinic Setting: The Variability of Response With Positively or Negatively Toned Questions

“…5 Standardization of question wording and survey administration methods are designed to remove variables that may contribute to undesired variation. Nonetheless, studies have demonstrated variation in questionnaire responses due to race/ethnicity, 17 changes in language concordance, 18 or verbal tone. 19,20 A variety of common method biases exist with questionnaires and these are difficult to define and measure.…”