Accounting for culture in patient focused care

Our study used a modified version of the CAHPS 3.0 Health Plan Survey to assess consumer ratings of performance within an Indian Health Service (IHS) Area that serves 10 tribes in two states. The CAHPS survey provides information on a number of dimensions of care that are substantially affected by inadequate funding, and on dimensions of care that IHS may have the ability to address through internal operational changes. This study provides information on the impact of under-funding on consumers’ assessment of the health services provided by IHS and on ratings of specific dimensions of care that IHS may be able to address to improve overall performance. Results of the study include the following:

1.    IHS CAHPS respondents’ ratings of their overall health care, personal physician, and specialists are lower than Medicaid CAHPS respondents’ ratings.

2.    IHS CAHPS respondents’ ratings of IHS are higher (though still lower than Medicaid respondents rate their care) on dimensions over which IHS has more control than on dimensions over which IHS has limited control.

3.    IHS CAHPS respondents who have a personal physician at IHS rate their overall care higher than do IHS respondents who do not have a personal physician.

4.    IHS CAHPS respondents who have alternate insurance coverage rate their care at IHS higher than do respondents who do not have alternative insurance coverage.

5.    IHS CAHPS respondents who practice traditional medicine or attend ceremonial healing ceremonies rate their overall health care lower than IHS respondents who do not practice traditional medicine or attend healing ceremonies.

This study is unique in that it involved the use of a new version of a standardized national survey, combined with customized questions, to determine and benchmark consumer satisfaction with IHS health care services. Psychometric analyses indicated that most of the composites maintained the strong psychometric properties in the survey data that are demonstrated in the general population. The methodology used to develop and to administer the survey can be used by others. Furthermore, the costs associated with the survey design, administration, and analysis are significantly lower than other methodologies discussed in the literature.      This study suggests the following lessons to improve the mainstream health system: (1) the use of customized versions of CAHPS surveys is an efficient and effective way to assess satisfaction with health care services received by underserved ethnic populations, (2) unique differences among underserved populations and/or their health care delivery systems should inform providers regarding realistic performance improvement initiatives, and (3) continued research regarding unique differences and expectations among underserved populations should be conducted to improve the delivery of and satisfaction with health care services.      The presentation will offer a narrated slide presentation to describe the study, followed by a question and answer session. Attendees will have access to survey instruments, techniques used to design the survey, and will be informed as to specific challenges encountered while conducting research among Native Americans.