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ABSTRACT: : Cultural competency has been espoused as an organizational strategy to reduce health disparities in care.
: To examine the relationship between hospital cultural competency and inpatient experiences with care.
: The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital's cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients.
: The National CAHPS Benchmarking Database's (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006.
: Dependent variables include 10 HCAHPS measures: 6 composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), 2 individual items (cleanliness and quietness of patient rooms), and 2 global items (overall hospital rating, and whether patient would recommend hospital).
: Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on 4 other dimensions: nurse communication, staff responsiveness, quiet room, and pain control.
: Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement.
Medical care 11/2012; 50 Suppl:S48-55. · 3.24 Impact Factor
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ABSTRACT: To determine whether positive parenting practices are associated with less aggressive and delinquent behavior in early-maturing girls.
Cross-sectional survey.
Interviews with a community sample of children and their caregivers were conducted in their homes or in a research setting.
An ethnically diverse cohort of 330 fifth-grade girls (mean age, 11.25 years) from 3 metropolitan areas.
Early onset of menarche, parental nurturance, knowledge of the child's activities, and communication.
Physical, relational, and nonphysical aggression and delinquent behavior.
A total of 25% of girls could be reliably classified as early maturers. Early maturation was associated with delinquency (b = 0.53) but not aggression. Low levels of maternal nurturance were associated with delinquency and relational aggression (both b = -0.04). Early maturation was associated with higher relational aggression only at low levels of nurturance (b = 0.94), communication (b = 1.36), and knowledge (b = 1.06) (P < .05 for each interaction). Also, early maturation only predicted physical aggression when combined with low maternal nurturance (b = 0.93).
Early puberty is a risk factor for delinquency, and early puberty combined with low parental nurturance, communication, or parental knowledge of the child's activities presents a risk for aggressive behavior in early adolescent girls. Early-maturing girls may benefit from increased parental nurturance, communication, and knowledge.
Archives of pediatrics & adolescent medicine 08/2008; 162(8):781-6. · 3.73 Impact Factor
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ABSTRACT: African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.
Archives of Sexual Behavior 06/2008; 37(5):736-47. · 3.53 Impact Factor
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ABSTRACT: Research has suggested that disordered gambling is endemic to Cambodian refugees. Whereas earlier study of the prevalence and correlates of disordered gambling has relied on convenience sampling, this investigation used a subset of a sample representative of the largest Cambodian refugee community in the US.
Face-to-face interviews assessing gambling disorder were conducted with a subsample of persons (N = 127) participating in a broader study of the mental health of this community.
13.9% of participants met screening criteria for lifetime disordered gambling, in contrast to previous research suggesting that prevalence rates may exceed 70%. After adjusting for a range of covariates, breadth of trauma exposure and marital status emerged as significant predictors of disordered gambling.
Given the myriad mental health challenges facing the Cambodian refugee community, these data indicate that scarce prevention and treatment resources may be more productively channeled toward addressing other mental health and social service needs.
Journal of Immigrant and Minority Health 11/2007; 11(1):35-40. · 1.16 Impact Factor
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ABSTRACT: Health plan members who did not need an interpreter in the past 6 months were compared with those who needed one and always, usually, sometimes, or never got one. In multivariate analyses, Hispanic and Asian/Pacific Islanders (API) members who needed interpreters and usually, sometimes, or never used one reported significantly worse (p < .05) provider and office staff communication, access to care, and health plan customer service compared with members who did not need interpreters. Hispanic and API members who needed and always used an interpreter reported similar or significantly better (p < .05) provider and office staff communication, access to care, and health plan customer service than members that did not need interpreters. Use of interpreters reduced White-Hispanic disparities in reports of care by up to 28 percent and White-API disparities by as much as 21 percent. Increasing use of interpreters could reduce racial/ethnic disparities and improve health plan performance.
Medical Care Research and Review 03/2006; 63(1):110-28. · 2.96 Impact Factor
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ABSTRACT: This study used multiple-group structural equation modeling to test a model explaining the association between exposure to televised sexual content and initiation of intercourse among an ethnically diverse national sample of 1,292 adolescents. The authors hypothesized, on the basis of social-cognitive theory, that exposure to televised sexual content would influence adolescents' safe-sex self-efficacy, sex-related outcome expectancies, and perceived peer norms regarding sex, and that each of these would, in turn, influence intercourse initiation. Findings support a model in which the relationship between exposure to TV's sexual content and intercourse initiation is mediated by safe-sex self-efficacy among African Americans and Whites but not among Hispanics. Outcome expectancies and perceived peer norms may also mediate the link between exposure and intercourse initiation among all 3 racial/ethnic groups, although evidence of this could not be confirmed.
Journal of Personality and Social Psychology 01/2006; 89(6):914-24. · 5.08 Impact Factor
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Michael Windle,
Jo Anne Grunbaum, Marc Elliott,
Susan R Tortolero,
Sandy Berry,
Janice Gilliland,
David E Kanouse,
Guy S Parcel,
Jan Wallander,
Steve Kelder,
Janet Collins,
Lloyd Kolbe,
Mark Schuster
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ABSTRACT: To provide an overview of a multisite, long-term study that focuses on risk and protective factors, health behaviors (e.g., dietary practices, physical inactivity, tobacco use, and violent activity), and health outcomes (e.g., diabetes, obesity, and sexually transmitted diseases) for a fifth-grade cohort to be followed biennially from ages 10 to 20 years.
A two-stage probability sampling procedure was used to select 5250 fifth-grade students from schools in Birmingham AL, Houston TX, and Los Angeles CA to ensure a sufficient sample size of African Americans, Hispanics, and non-Hispanic whites, to support precise statistical inferences. Computer-assisted technology was used to collect data from children and their primary caregivers. Teachers and other school personnel responded to questionnaires, and observational procedures were used to obtain information about schools and neighborhoods.
To exploit the multilevel, multimethod structure of the data, statistical models include latent-growth mixture modeling, multilevel modeling, time-series analysis, survival analysis, latent transition analysis, and structural equation modeling. Analyses focus both on the co-occurrence and predictors of growth trajectories for different health behaviors across time.
By using a prospective research design and studying the predictors and time course of multiple health behaviors with a multilevel, multimethod assessment protocol, this research project could provide an empirical basis for effective social and educational policies and intervention programs that foster positive health and well-being during both adolescence and adulthood.
American Journal of Preventive Medicine 09/2004; 27(2):164-72. · 4.04 Impact Factor
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ABSTRACT: To assess physician recognition of dementia and cognitive impairment, compare recognition with documentation, and identify physician and patient factors associated with recognition.
Survey of physicians and review of medical records.
Health maintenance organization in southern California.
Seven hundred twenty-nine physicians who provided care for women participating in a cohort study of memory (Women's Memory Study).
Percentage of patients with dementia or cognitive impairment (using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire) recognized by physicians. Relationship between physician recognition and patient characteristics and physician demographics, practice characteristics, training, knowledge, and attitudes about dementia.
Physicians (n=365) correctly identified 81% of patients with dementia and 44% of patients with cognitive impairment without definite dementia. Medical records documented cognitive impairment in 83% of patients with dementia and 26% of patients with cognitive impairment without definite dementia. In a multivariable model, physicians with geriatric credentials (defined as geriatric fellowship experience and/or the certificate of added qualifications) recognized cognitive impairment more often than did those without (risk ratio (RR)=1.56, 95% confidence interval (CI)=1.04-1.66). Physicians were more likely to recognize cognitive impairment in patients with a history of depression treatment (RR=1.3, 95% CI=1.03-1.45) or stroke (RR=1.37, 95% CI=1.04-1.45) and less likely to recognize impairment in patients with cognitive impairment without definite dementia than in those with dementia (RR=0.46, 95% CI=0.23-0.72) and in patients with a prior hospitalization for myocardial infarction (RR=0.37, 95% CI=0.09-0.88) or cancer (RR=0.49, 95% CI=0.18-0.90).
Medical record documentation reflects physician recognition of dementia, yet physicians are aware of, but have not documented, many patients with milder cognitive impairment. Physicians are unaware of cognitive impairment in more than 40% of their cognitively impaired patients. Additional geriatrics training may promote recognition, but systems solutions are needed to improve recognition critical to provision of emerging therapies for early dementia.
Journal of the American Geriatrics Society 08/2004; 52(7):1051-9. · 3.74 Impact Factor
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ABSTRACT: This paper examines the applicability of a leading patient survey, the Consumer Assessments of Health Plans Study (CAHPS), to Preferred Provider Organizations (PPOs) in the United States.
Elite interviews were conducted with users of the CAHPS survey in PPO settings.
Study participants attended either the California Healthcare Foundation Quality Performance Measurement in Preferred Provider Organizations Forum or the National Conference to Examine PPO Quality. Eleven representatives of state and federal government health care purchasers, commercial PPO plans, and survey vendors were included.
The interview included 21 questions addressing experiences with and concerns about using the CAHPS survey in PPO settings.
Respondents raised concerns about the influence of out-of-network care on CAHPS reports and ratings of PPO health plans. Suggestions were made for additional PPO-relevant items such as after-hours care, numbers and types of specialists in the PPO network, and disease management.
Modifications to some of the CAHPS survey items are needed to address concerns of users about their applicability in PPO settings.
International Journal for Quality in Health Care 07/2004; 16(3):219-27. · 1.96 Impact Factor
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ABSTRACT: The primary objective of this study was to investigate whether Medicaid managed care enrollees and commercially insured health
plan participants respond differently to the CAHPS® 2.0 health plan survey global ratings of health care, personal doctor or nurse, and health plan. A secondary objective was
to examine whether and how these differences may vary by alternative approaches to collapsing the 0-10 response scale. This
study is a secondary analysis of CAHPS 2.0 health plan survey data collected in 1999 and 2000. Data on 2,142 Iowa Medicaid
managed care enrollees and 1,051 commercially insured State of Iowa employees were analyzed. Differences in responses between
the Medicaid-enrolled and commercially insured respondents were modeled using multinomial logistic regression, adjusting for
demographics, health status and CAHPS composite measures. Results of these analyses indicated that Medicaid enrollees were
significantly more likely than State of Iowa employees to use the extreme ends of the CAHPS global rating scales, particularly
in the approaches when the category representing the highest end of the scale was defined as a score of 10 for the analysis.
Thus, the choice of cut points for collapsing the 0-10 scales influenced statistical differences on CAHPS global ratings of
care, doctor and health plan between Medicaid and privately insured populations. In conclusion, a populations use of the extremes
of the global rating scales should be considered when comparing or combining CAHPS data for different populations. If response
contraction bias is present, a format such as the alternative approach presented here (using categories 0-4, 5-8, 9, 10) that
captures that bias may be preferable to the CAHPS format, which has been shown to maximize plan differentiation.
Health Services and Outcomes Research Methodology 01/2004; 5(3):193-205.
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ABSTRACT: Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language.
Data were derived from the National CAHPS Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000.
The CAHPS data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent.
Data were analyzed using linear regression models. The dependent variables were CAHPS 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health.
Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.
This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid-enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.
Health Services Research 07/2003; 38(3):789-808. · 2.16 Impact Factor
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ABSTRACT: Objective. Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language.Data Sources. Data were derived from the National CAHPS® Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000.Data Collection. The CAHPS® data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent.Study Design Data were analyzed using linear regression models. The dependent variables were CAHPS® 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health.Principal Findings. Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.Conclusions This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid-enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.
Health Services Research 05/2003; 38(3):789 - 808. · 2.16 Impact Factor
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ABSTRACT: A previously identified communication behavior, online commentary, is physician talk that describes what he/she is seeing, feeling, or hearing during the physical examination of the patient. The investigators who identified this communication behavior hypothesized that its use may be associated with successful physician resistance to perceived or actual patient expectations for inappropriate antibiotic medication. This paper examines the relationship between actual and perceived parental expectations for antibiotics and physician use of online commentary as well as the relationship between online commentary use and the physician's prescribing decision. We conducted a prospective observational study in two private pediatric practices. Study procedures included a pre-visit parent survey, audiotaping of study consultations, and post-visit surveys of the participating physicians. Ten pediatricians participated (participation rate=77%) and 306 eligible parents participated (participation rate=86%) who were attending sick visits for their children with upper respiratory tract infections between October 1996 and March 1997. The main outcomes measured were the proportion of consultations with online commentary and the proportion of consultations where antibiotics were prescribed. Two primary types of online commentaries were observed: (1) online commentary suggestive of a problematic finding on physical examination that might require antibiotic treatment ('problem' online commentary), e.g., "That cough sounds very chesty"; and (2) online commentary that indicated the physical examination findings were not problematic and antibiotics were probably not necessary ('no problem' online commentary), e.g., "Her throat is only slightly red". For presumed viral cases where the physician thought the parent expected to receive antibiotics, if the physician used at least some 'problem' online commentary, he/she prescribed antibiotics in 91% (10/11) of cases. Conversely, when the physician exclusively employed 'no problem' online commentary, antibiotics were prescribed 27% (4/15) of the time (p = 0.07). Use of 'no problem' online commentary did not add significantly to visit length. 'No problem' online commentary is a communication technique that may provide an effective and efficient method for resisting perceived expectations to prescribe antibiotics.
Social Science [?] Medicine 02/2003; 56(2):313-20. · 2.70 Impact Factor
