The Association Between Care Experiences and Parent Ratings of Care for Different Racial, Ethnic, and Language Groups in a Medicaid Population

Wilkins V, Elliott MN, Richardson A, Lozano P, Mangione-Smith R
Source: Health Serv Res
Publication Year: 2011
Patient Need Addressed: Patient satisfaction/engagement
Population Focus: Medicaid beneficiaries
Demographic Group: Child, Racial and ethnic minority groups
Study Design: Other Study Design
Type of Literature: White

To examine the association between care experiences and parent ratings of care within racial/ethnic/language subgroups.

National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database 3.0 (2003-2006). Sample Characteristics. 111,139 parents of minor Medicaid managed care enrollees.

Cross-sectional observational study predicting “poor” (0-5 on 0-10 scale) parent ratings of personal doctor, specialist, healthcare, and health plan from care experiences for different parent race/ethnicity/language subgroups (Latino/Spanish, Latino/English, white, and black).

Care experiences had similar associations with the probability of poor parent ratings of care across the four racial/ethnic/language subgroups (p>.20). A one standard deviation improvement in the doctor communication care experience was associated with about half the frequency of poor ratings of care for personal doctor and healthcare in all subgroups (p<.05). Sensitivity analysis of individual communication items found that failure to provide explanations to children predicted poor ratings of care only among whites, who also weighed the length of physician interaction more heavily than other subgroups. CONCLUSIONS:
Communication-based interventions may improve experiences and ratings of care for all subgroups, although implementation of these interventions may need to consider preferences associated with race, ethnicity, and language.

Insights Results

Overview of article

  • This study examines the relationship between parent experiences of care to better understand whether future interventions to improve pediatric care experiences and ratings should be differentially tailored to racial/ethnic/minority groups
    Method of article
  • The research team analyzed data from the National Consumer Assessment of Healthcare Providers and Systems (CHAPS) Benchmarking Database 3.0 (NCBD 3.0) Child Medicaid CAHPS Surveys. Data included plans in 26 states


  • Although originally hypothesized that the care experiences that were most associated with a particular rating of care might differ across racial/ethnic/language subgroups, this study found that a uniform emphasis on improving the same care experience domains for all racial/ethnic/language subgroups might be appropriate and might lead to similar improvements in CAHPS ratings for all groups. The different racial/ethnic/language subgroups appear to have similar concerns and seem to care about them to a similar extent
  • 5.9 % of parents assigned poor ratings of care to their child’s doctor, 8.3 % to specialists, 6.7 % to their child’s healthcare, and 7.3 % to their health plan
  • Doctor communication was the most important domain for all global ratings of care except for the health plan rating, especially failure to listening to parents or spending enough time with the child may be consequential
  • Overall, lower mean care experiences for doctor communication were the strongest predictor of rating a child’s personal doctor and healthcare poorly. Additionally, poor ratings of specialist were most closely associated with the getting needed care composite and poor ratings of health plan were most strongly associated with the customer service measure
  • Spending enough time at the doctor was less associated with care ratings for Latino/Spanish parents and by black parents

Key takeaways/implications

  • Quality improvement interventions targeting communication thus may improve care experiences and satisfaction for all groups and should receive particular emphasis. However, the content of these interventions may need to be tailored for the specific subgroups studied
  • Limitations to this study include low response rates of CAHPS Medicaid surveys, nonresponse bias, non-evaluation of other minority groups (e.g., Asian populations), and lack of causality