Advances in Measuring Culturally Competent Care A Confirmatory Factor Analysis of CAHPS-CC in a Safety-Net Population

作者：Stern Rachel J; Fernandez Alicia; Jacobs Elizabeth A; Neilands Torsten B; Weech Maldonado Robert; Quan Judy; Carle Adam; Seligman Hilary K^*

来源：Medical Care, 2012, 50(9): S49-S55.

DOI：10.1097/MLR.0b013e31826410fb

• cultural competency
• factor analysis
• minority health

Background: Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. %26lt;br%26gt;Methods: We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n = 600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. %26lt;br%26gt;Results: A 7-factor model demonstrated satisfactory fit (chi(2)(231) = 484.34, P %26lt; 0.0001) with significant factor loadings at P %26lt; 0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (alpha = 0.82), Trust (alpha = 0.77), and Doctor Communication-Health Promotion (alpha = 0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (alpha = 0.54), Equitable Treatment (alpha = 0.69), Doctor Communication-Alternative Medicine (a = 0.52), and Shared Decision-Making (alpha = 0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. %26lt;br%26gt;Conclusions: Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.

• 出版日期2012-9