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  • Measure Summary
  • NQMC:010094
  • Sep 2011

Patients' experiences: percentage of patients who reported whether they perceived discrimination because of tribal affiliation.

CAHPS® American Indian Survey. Version: adult. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Mar 4. 11 p.
Patient experience measures for the CAHPS® American Indian Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 8 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Patient Experience

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients who reported whether they perceived discrimination because of tribal affiliation.

The "Perceived Discrimination Because of Tribal Affiliation" composite measure is based on two items on the CAHPS American Indian Survey. One question asks patients whether ("Yes" or "No"):

  • Patient felt provider judged them unfairly or treated them with disrespect because of your tribal affiliation?

AND

One question asks patients whether ("Yes," "No," or "Not sure"):

  • Provider judged you unfairly or treated you with disrespect because of blood quantum level

Note: This is not a general measure of discrimination.

Rationale

In collaboration with the Choctaw Nation Health Services (CNHS), the Agency for Healthcare Research and Quality (AHRQ) and RAND Corporation developed the American Indian Survey to allow the CNHS and other tribal populations to assess patients' experiences with Indian health care facilities. These partners recognized the importance of developing a survey that could be used to measure patient experience of care for a population that was vulnerable, traditionally under-served, and had higher rates of poor health outcomes than the U.S. non-Hispanic White population.

The CAHPS American Indian Survey is used for these purposes:

  1. To collect and measure patient experience of care,
  2. To help American Indian tribes make valid comparisons across tribal outpatient clinics; and
  3. To support the clinics in their efforts to evaluate the need for internal quality improvements.

In order to meet the circumstances and needs of the American Indian population, the survey's measures reflect how health services are organized and delivered in tribal clinics. Survey items are reworded from the CAHPS Clinician and Group Survey to include terms or phrases familiar to the CNHS/Indian patient population. For example, the term health professional was substituted for the term health provider as the former was more widely used and recognized by CNHS patients. Additionally, the survey includes items on perceived discrimination due to the evidence that Native Americans are less likely to trust health care providers, clinics, and hospitals than non-Hispanic Whites.

Evidence for Rationale

Guadagnolo BA, Cina K, Helbig P, Molloy K, Reiner M, Cook EF, Petereit DG. Medical mistrust and less satisfaction with health care among Native Americans presenting for cancer treatment. J Health Care Poor Underserved. 2009 Feb;20(1):210-26. PubMed External Web Site Policy

Johansson P, Jacobsen C, Buchwald D. Perceived discrimination in health care among American Indians/Alaska natives. Ethn Dis. 2006;16(4):766-71. PubMed External Web Site Policy

Ogunwole S. We the people: American Indians and Alaska natives in the United States. Census 2000 Special Reports. Washington (DC): U.S. Census Bureau; 2006.

Weidmer-Ocampo B, Johansson P, Dalpoas D, Wharton D, Darby C, Hays RD. Adapting CAHPS for an American Indian population. J Health Care Poor Underserved. 2009 Aug;20(3):695-712. PubMed External Web Site Policy

Primary Health Components

Patient experience; discrimination; tribal affiliation; American Indian

Denominator Description

All patients who answered the "Perceived Discrimination Because of Tribal Affiliation" items on the CAHPS American Indian Survey

Numerator Description

The number of "Yes" or "No" and "Yes," "No," or "Not sure" responses on the "Perceived Discrimination Because of Tribal Affiliation" items (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • Focus groups

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Development of the CAHPS American Indian Survey included:

  • Cognitive testing. In the summer of 2004, the RAND members of the CAHPS team conducted cognitive testing of the first draft of the CAHPS American Indian Survey with 20 subjects recruited from 3 Choctaw Nation Health Services (CNHS) outpatient clinics. These tests indicated a generally high level of relevance among the survey items and domains, and few problems in terms of respondent comprehension. They also revealed a need for some revision to clarify service structures in specific clinics and to allow CNHS to gather clinic-specific information.
  • Field testing. In the summer of 2005, RAND fielded a revised draft instrument, with 81 items and 16 domains. RAND, Agency for Healthcare Research and Quality (AHRQ), and CNHS worked together to develop specifications for drawing the sample, which included 1200 randomly selected adults who had visited any of five CNHS outpatient clinics. The administration mode was two-wave mail only, which achieved an overall response rate of 58%.

An analysis of the field test results indicated that the draft instrument by and large demonstrated a high level of reliability and measured its intended domains well. Based on their findings, the CAHPS team made only a few modifications to the questionnaire, namely minimizing the perceived discrimination composite from 6 to 2 items, and removing one item from the health education composite.

Evidence for Extent of Measure Testing

Agency for Healthcare Research and Quality (AHRQ). Development of the CAHPS American Indian Survey. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [accessed 2015 Jun 08].

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients who answered the "Perceived Discrimination Because of Tribal Affiliation" items on the CAHPS American Indian Survey

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
The number of "Yes" or "No" and "Yes," "No," or "Not sure" responses on the "Perceived Discrimination Because of Tribal Affiliation" items

From the responses, a composite score is calculated in which a higher score indicates better quality. The composite top box score is the mean across all items of the percentage of survey respondents who chose the most positive response.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

CAHPS® American Indian Survey

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Mean/Median

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Case-mix adjustment

Description of Allowance for Patient or Population Factors

The CAHPS Team recommends adjusting the survey data for respondent age, education, and general health status. This makes it more likely that reported differences are due to real differences in performance, rather than differences in the characteristics of enrollees or patients.

CAHPS recommends adjusting for the case-mix of the patients who evaluated each provider to allow comparison of scores across providers.

Refer to the Instructions for Analyzing Data from CAHPS® Surveys document (see also the "Companion Documents" field) for additional information.

Standard of Comparison

Internal time comparison

Original Title

Perceived discrimination because of tribal affiliation.

Measure Collection Name

CAHPS American Indian Survey

Submitter

Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]

Developer

Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]

CAHPS Consortium - Health Care Quality Collaboration

Choctaw Nation Health Services

RAND Corporation - Nonprofit Research Organization

Funding Source(s)

Agency for Healthcare Research and Quality (AHRQ)

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2011 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

CAHPS® American Indian Survey. Version: adult. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Mar 4. 11 p.

Patient experience measures for the CAHPS® American Indian Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 8 p.

Measure Availability

CAHPS® American Indian Survey available from the CAHPS Web site External Web Site Policy.

For more information, contact the CAHPS Help Line.

Companion Documents

The following is available:

  • Instructions for analyzing data from CAHPS® surveys: using the CAHPS analysis program version 4.0. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Apr 2. 75 p. This document is available from the CAHPS Web site External Web Site Policy.
  • What's available for the CAHPS® American Indian Survey. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2011 Sep 1. 3 p. This document is available from the CAHPS Web site External Web Site Policy.

For more information, contact the CAHPS Help Line.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 12, 2015. The information was verified by the measure developer on September 28, 2015.

Copyright Statement

No copyright restrictions apply.

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