Arnold G, Baranowski R. — American Board of Internal Medicine
Presented: Joint Statistical Meetings Conference, August 2013
Objective: The purpose of this study was to compare patient ratings of primary care physicians on three composite measures related to provider communication skills (6 items), shared decision-making (2 items), and overall satisfaction (11-point rating scale).
Method: Measures were adapted from practice-based Clinician and Group (CG) CAHPS surveys in English or Spanish; surveys were completed anonymously (minimum of 25 responses) using an automated phone or Web system. Responses could differ among patients because measurement constructs may not translate well between languages. If latent constructs are interpreted by Spanish- and English-speaking patients similarly, then covariance structures for the same physicians would be indistinguishable after controlling for differences unrelated to language (e.g., health status, education). Patient ratings were obtained for 79 physicians who administered surveys to both Spanish-speaking patients (301 cases) and English-speaking patients (1,708 controls). A second control group included 2,048 ratings (English only) of another 79 physicians who were propensity-matched to each study physician based on 31 practice, demographic, training and achievement characteristics and nine patient demographic variables. Groups were divided into 49 training pairs and 30 testing pairs for validation. A three-group, MIMIC structural equation model was adapted to the Spanish-speaking group and the two English-speaking groups.
Results: The covariance structures were not equivalent, and a series of hypothesis tests suggested that language factor structures were the same for Spanish and English patients (p=.061), but the factor loadings for items differed (p=.003). There was a significant propensity score interaction with group membership, suggesting that differences between groups were not due to selection alone (p<.001).
Conclusion: Patients' ratings on three provider types had similar structural relationships among latent constructs but showed differential item functioning by language. The study suggests that structural equation models may be useful in assessing whether different language groups vary with respect to what constitutes good communication skills in their health care providers, the quality of the items used to measure constructs, and whether propensity score matching works uniformly across groups.
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