Dataset Information

Differential item functioning by survey language among older Hispanics enrolled in Medicare managed care: a new method for anchor item selection.

ABSTRACT: OBJECTIVE:To propose a permutation-based approach of anchor item detection and evaluate differential item functioning (DIF) related to language of administration (English vs. Spanish) for 9 questions assessing patients' perceptions of their providers from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare 2.0 survey. METHOD AND STUDY DESIGN: CAHPS 2.0 health plan survey data collected from 703 Hispanics who completed the survey in Spanish were matched on personal characteristics to 703 Hispanics that completed the survey in English. Steps to be followed for the detection of anchor items using the permutation tests are proposed and these tests in conjunction with item response theory were used for the identification of anchor items and DIF detection. RESULTS:Of the questions studied, 4 were selected as anchor items and 3 of the remaining questions were found to have DIF (P < 0.05). The 3 questions with DIF asked about seeing the doctor within 15 minutes of the appointment time, respect for what patients had to say, and provider spending enough time with patients. CONCLUSIONS:Failure to account for language differences in CAHPS survey items may result in misleading conclusions about disparities in health care experiences between Spanish and English speakers. Statistical adjustments are needed when using the items with DIF.

SUBMITTER: Setodji CM

PROVIDER: S-EPMC4166561 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Differential item functioning by survey language among older Hispanics enrolled in Medicare managed care: a new method for anchor item selection.

Setodji Claude Messan CM Reise Steven P SP Morales Leo S LS Fongwa Marie N MN Hays Ron D RD

Medical care 20110501 5

<h4>Objective</h4>To propose a permutation-based approach of anchor item detection and evaluate differential item functioning (DIF) related to language of administration (English vs. Spanish) for 9 questions assessing patients' perceptions of their providers from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare 2.0 survey. METHOD AND STUDY DESIGN: CAHPS 2.0 health plan survey data collected from 703 Hispanics who completed the survey in Spanish were matched on persona ...[more]

PMID: 21422959

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Project description:ObjectivesThis study uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS((R))) survey to examine the experiences of Hispanics enrolled in Medicare managed care. Evaluations of care are examined in relationship to primary language (English or Spanish) and region of the country.Data sourcesCAHPS 3.0 Medicare managed care survey data collected in 2002.Study designThe dependent variables consist of five CAHPS multi-item scales measuring timeliness of care, provider communication, office staff helpfulness, getting needed care, and health plan customer service. The main independent variables are Hispanic primary language (English or Spanish) and region (California, Florida, New York/New Jersey, and other states). Ordinary least squares regression is used to model the effect of Hispanic primary language and region on CAHPS scales, controlling for age, gender, education, and self-rated health.Data collection/extraction methodsThe analytic sample consists of 125,369 respondents (82 percent response rate) enrolled in 181 Medicare managed care plans across the U.S. Of the 125,369 respondents, 8,463 (7 percent) were self-identified as Hispanic. The survey was made available in English and Spanish, and 1,353 Hispanics completed one in Spanish.Principal findingsHispanic English speakers had less favorable reports of care than whites for all dimensions of care except provider communication. Hispanic Spanish speakers reported more negative experiences than whites with timeliness of care, provider communication, and office staff helpfulness, but better reports of care for getting needed care. Spanish speakers in all regions except Florida had less favorable scores than English-speaking Hispanics for provider communication and office staff helpfulness, but more positive assessments for getting needed care. There were greater regional variations in CAHPS scores among Hispanic Spanish speakers than among Hispanic English speakers. Spanish speakers in Florida had more positive experiences than Spanish speakers in other regions for most dimensions of care.ConclusionsHispanics in Medicare managed care face barriers to care; however, their experiences with care vary by language and region. Spanish speakers (except FL) have less favorable experiences with provider communication and office staff helpfulness than their English-speaking counterparts, suggesting language barriers in the clinical encounter. On the other hand, Spanish speakers reported more favorable experiences than their English-speaking counterparts with the managed care aspects of their care (getting needed care and plan customer service). Medicare managed care plans need to address the observed disparities in patient experiences among Hispanics as part of their quality improvement efforts. Plans can work with their network providers to address issues related to timeliness of care and office staff helpfulness. In addition, plans can provide incentives for language services, which have the potential to improve communication with providers and staff among Spanish speakers. Finally, health plans can reduce the access barriers faced by Hispanics, especially among English speakers.

Project description:IntroductionThe outcomes anxiety and depression are measured frequently by healthcare providers to assess the impact of a disease, but with numerous instruments. PROMIS item banks provide an opportunity for standardized measurement. Cross-cultural validity of measures and the availability of reference values are prerequisites for standardized measurement.MethodsPROMIS Anxiety and Depression item banks were completed by 1002 representative Dutch persons. To evaluate cross-cultural validity, data from US participants in PROMIS wave 1 were used and differential item functioning (DIF) was investigated, using an iterative hybrid of logistic regression and item response theory. McFadden's pseudo R2-change of 2% was the critical threshold. The impact of any DIF on full item banks and short forms was investigated. To obtain Dutch reference values, T-scores for anxiety and depression were calculated for the complete Dutch sample, and age-group and gender subpopulations. Thresholds corresponding to normal limits, mild, moderate and severe symptoms were computed.ResultsIn both item banks, two items had DIF but with minimal impact on population level T-scores for full item banks and short forms. The Dutch general population had a T-score of 49.9 for anxiety and 49.6 for depression, similar to the T-scores of 50.0 of the US general population. T-scores for age-group and gender subpopulations were also similar to T-scores of the US general population. Thresholds for mild, moderate and severe anxiety and depression were set to 55, 60 and 70, identical to US thresholds.ConclusionsThe limited number of items with DIF and its minimal impact, enables the use of standard (US) item parameters and comparisons of scores between Dutch and US populations. The Dutch reference values provide an important tool for healthcare professionals and researchers to evaluate and interpret symptoms of anxiety and depression, stimulating the uptake of PROMIS measures, and contributing to standardized outcome measurement.

Dataset Information

Differential item functioning by survey language among older Hispanics enrolled in Medicare managed care: a new method for anchor item selection.

Publications

Differential item functioning by survey language among older Hispanics enrolled in Medicare managed care: a new method for anchor item selection.

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