Differences by Survey Language and Mode among Chinese Respondents to a CAHPS Health Plan Survey

Less Use of Extreme Response Options by Asians to Standardized Care Scenarios May Explain Some Racial/Ethnic Differences in CAHPS Scores

“…Other studies have shown that non-English-preferring Asians tend to exhibit even lower ERT than English-preferring Asians. 3,5,18 These findings, along with those from our study, suggest that direct case-mix adjustment for Asian race/ethnicity, or indirect adjustment such as Asian language spoken at home (recently adopted for HCAHPS) 43 or Asian survey language (as used for MA/PDP CAHPS), 25 may improve the measurement of the quality of care provided by physicians, medical groups, hospitals, and health plans. Such adjustments would have little effect for most providers, but would be likely to notably and correctly increase the scores of those with large proportions of Asian patients.…”

“…Because of the skewness of CAHPS scores, in which most ratings fall in the most positive categories (eg, 9 or 10 on a 0-10 rating scale), 24 avoidance of the extremes (low ERT) by Asians could result in lower mean scores overall, as avoiding positive extremes lowers the mean, and the negative extreme is rare enough to have little consequence. 18,25 Much of the extant evidence on ERT comes from observational data. To more confidently assess whether certain patient groups use experience with care response scales differently, the care being rated needs to be held constant.…”

Effects of Caregiver and Decedent Characteristics on CAHPS Hospice Survey Scores

“…Although adequately precise single-quarter Chinese-language CMA is not possible, several hospices would be adversely affected without adjustment, given strong negative associations with CAHPS scores. 14,15 We therefore more precisely estimate the Chinese-language marginal effect pooled for more than eight quarters, adjusting hospices with >10% Chinese language responses after CMA (results not discussed).…”

Using predicted Spanish preference to target bilingual mailings in a mail survey with telephone follow‐up

“…While more than half of those in the MCAHPS sample who are listed administratively as non‐Hispanic White complete a survey, less than one‐third of those identified as Hispanic or Asian do . Compared to beneficiaries of the same race/ethnicity who answer in English, beneficiaries who prefer non‐English languages (eg, Spanish, Chinese) have lower scores on CAHPS composites . Increasing response rates for those who prefer languages other than English may improve the representativeness of seniors particularly vulnerable to poor care experiences.…”

“…13,14 Compared to beneficiaries of the same race/ethnicity who answer in English, beneficiaries who prefer non-English languages (eg, Spanish, Chinese) have lower scores on CAHPS composites. [14][15][16][17][18] Increasing response rates for those who prefer languages other than English may improve the representativeness of seniors particularly vulnerable to poor care experiences.…”