Diabetes in California: Findings From the 2001 California Health Interview Survey

Examines the prevalence of diabetes in California, with particular attention paid to disparities between different population groups. Includes access to medical care, diabetes care and management, and identifying at-risk populations

Unveiling SEER-CAHPS®: A New Data Resource for Quality of Care Research

BACKGROUND: Since 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care. OBJECTIVE: To describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient surveys and the NCI’s Surveillance, Epidemiology and End Results (SEER) data. DESIGN: This is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients’ global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973–2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002–2011) for fee-for-service beneficiaries on utilization and costs of care. PARTICIPANTS: In total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort. MAIN MEASURES: The data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys. KEY RESULTS: Sizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage. CONCLUSIONS: SEER-CAHPS is a valuable resource for information about Medicare beneficiaries’ experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance

Patient-Provider Communication During Posttreatment Breast Cancer Care: Findings From a Kaiser Permanente Northern California Pilot Project

Background: Patient-provider communication is essential to delivering high-quality cancer care, including posttreatment when survivors have many complex care needs. In this study, we used data collected for quality improvement from a small feasibility sample to examine patient perceptions of provider communication and inform the development of a new Oncology Survivorship Clinic model. Methods: As part of a pilot project conducted at Kaiser Permanente Northern California, we surveyed 51 breast cancer patients posttreatment. The survey included a communication measure from the 2011 Medical Expenditure Panel Survey: Experiences with Cancer Survivorship Supplement evaluating provider discussions of: 1) surveillance for recurrence, 2) late or long-term treatment effects, 3) healthy lifestyle behaviors, and 4) emotional or social needs. We also examined reports of the 6 core functions of patient-centered communication (ie, managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, exchanging information) using a measure from the Health Information National Trends Survey 4: Cycle 4. Part of the purpose was to evaluate acceptability of a new Oncology Survivorship Clinic utilizing nonphysician providers. Results: The sample included 51 breast cancer patients surveyed in 2016 within 6 months of treatment completion. All women were stage 0–3. Overall, sizable proportions received detailed communication about surveillance (65%), treatment side effects (46%), emotional needs (41%) and healthy lifestyles (71%), and the majority received patient-centered communication (range: 60%–73% based on core function). Particular gaps were noted related to provider communication about treatment side effects (54%), emotional/social needs (59%), managing uncertainty (35%) and responding to emotions (40%). Conclusion: Our very preliminary findings suggest that the majority of women had positive communication experiences, including with nonphysician providers. However, clear communications gaps existed, underscoring future avenues for research and care delivery interventions to address the needs of breast cancer patients more comprehensively

Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items between Whites and Asians.

PurposeAsians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. We examined responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicare survey items by Whites and Asians, controlling for underlying level on the CAHPS constructs.MethodsWe conducted multiple group analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled data from 2007 to 2011. Responses were obtained from 1,326,410 non-Hispanic Whites and 40,672 non-Hispanic Asians (hereafter referred to as Whites and Asians). The median age for Whites was 70, with 24 % 80 or older, and 70 for Asians, with 23 % 80 or older. Fifty-eight percent of Whites and 56 % of Asians were female.ResultsA model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates (7 factor loadings, 3 measured variable errors, and 2 item intercepts): Comparative Fit Index = 0.947 and 0.948; root-mean-square error of approximation = 0.052 and 0.052, respectively). Differences in latent CAHPS score means between Whites and Hispanics estimated from the two models were similar, differing by 0.053 SD or less.ConclusionsThis study provides support for measurement equivalence of the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparisons of care experiences between the two groups

Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between non-Hispanic whites and Asians

259 Background: Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. To examine measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between Whites and Asians. Methods: We conducted multiple group confirmatory factor analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for three CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled CAHPS data from 2007-2011. Responses were obtained from non-Hispanic whites (n = 1,326,410) and Asians (n = 40,672). The median age for whites was 70, with 24% 80 or older, and 70 for Asians, with 23% 80 or older. Fifty-eight percent of the whites and 56% of the Asians were female. Results: A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates suggested by Lagrange multiplier tests (Comparative Fit Index = 0.922, Root Mean Square Error of Approximation = 0.064). Three of the 12 group-specific estimates consisted of 7 factor loadings, 3 measured variable errors, and 2 item intercepts. Six of the factor loadings were larger for Asians than for whites. Conclusions: This study provides general support for measurement equivalence in response to the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparison of care experiences for the two groups

Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between non-Hispanic whites and Asians

259 Background: Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. To examine measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between Whites and Asians. Methods: We conducted multiple group confirmatory factor analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for three CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled CAHPS data from 2007-2011. Responses were obtained from non-Hispanic whites (n = 1,326,410) and Asians (n = 40,672). The median age for whites was 70, with 24% 80 or older, and 70 for Asians, with 23% 80 or older. Fifty-eight percent of the whites and 56% of the Asians were female. Results: A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates suggested by Lagrange multiplier tests (Comparative Fit Index = 0.922, Root Mean Square Error of Approximation = 0.064). Three of the 12 group-specific estimates consisted of 7 factor loadings, 3 measured variable errors, and 2 item intercepts. Six of the factor loadings were larger for Asians than for whites. Conclusions: This study provides general support for measurement equivalence in response to the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparison of care experiences for the two groups

Diabetes in California: Nearly 1.5 Million Diagnosed and 2 Million More at Risk

Diabetes is the seventh leading cause of death in the United States; a major cause of nontraumatic amputations, blindness, and endstage kidney disease; and a significant risk factor for coronary heart disease and stroke. In California, as growing rates of obesity send the rates of Type 2 diabetes to unprecedented levels,there are also troubling indications of insufficient efforts at prevention and education, as well as barriers in the health care system that are resulting in an alarming number of cases in which diabetes is not appropriately managed,putting individuals in jeopardy. This policy brief presents these and other findings from the 2001 California Health Interview Survey (CHIS 2001), California’s largest representative health survey of the state and its counties