New tools can help assess culturally competent and health-literate care

The latest additions to a set of surveys for evaluating patient experiences with medical care provide new tools for assessing culturally competent and health-literate care, according to a special September supplement to Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The supplement focuses on the development and evaluation of new questions, or "item sets," added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys. "These item sets embody the growing commitment of the CAHPS® program to produce surveys that can be used for quality improvement and reporting purposes," according to a foreword by Dr Carolyn Clancy, Director of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, and colleagues. CAHPS® is a registered trademark of AHRQ.

New Tools for Assessing Culturally Competent and Health-Literate Care
The goal of the CAHPS® surveys is to provide patients with a way of reporting on their experiences with health care services. "CAHPS® surveys go beyond producing patient satisfaction ratings by asking patients to report on their experiences with health care services," Dr Clancy and coauthors explain. The goal is to provide feedback on health care quality that is "more specific, actionable, understandable, and objective" than general ratings.

The CAHPS Cultural Competence item set was developed to promote and measure the provision of care that is "culturally and linguistically appropriate." Patients are asked to share their experiences in the health care system with issues such as language access, trust, complementary and alternative medicine, communication, and discrimination.

Supplement papers assess the new item set's performance in evaluating care across different racial/ethnic categories and languages, including English and Spanish versions. One study reports its use in evaluating the experiences of low-income, uninsured patients receiving care at "safety net" clinics.

Two papers provide initial evidence linking culturally competent care to improved outcomes in patients with diabetes—not only in controlling blood sugar levels, but also in lessening the emotional burden of living with the disease. Another paper provides evidence that patients commonly perceive discrimination based on race/ethnicity and Medicaid insurance status, and that perceptions of discrimination are associated with lower ratings of care.

The supplement also covers the development and evaluation of CAHPS® survey items designed to evaluate how well providers address health literacy—that is, patients' varying abilities to obtain and understand the basic health information and services they need to make appropriate health decisions.

Items range from questions about communication with health care providers and medicine instructions, to whether patients are offered help filling out forms. The health literacy data set "breaks new ground by measuring, from the patient's perspective, to what extent health care professionals have succeeded in reducing health literacy demands," according to Dr. Clancy and colleagues.