Leo S. Morales

The RAND-36 measure of health-related quality of life

The RAND-36 is perhaps the most widely used health-related quality of life (HRQoL) survey instrument in the world today. It is comprised of 36 items that assess eight health concepts: physical functioning, role limitations caused by physical health problems, role limitations caused by emotional problems, social functioning, emotional well-being, energy/fatigue, pain, and general health perceptions. Physical and mental health summary scores are also derived from the eight RAND-36 scales. This paper provides example applications of the RAND-36 cross-sectionally and longitudinally, provides information on what a clinically important difference is for the RAND-36 scales, and provides guidance for summarizing the RAND-36 in a single number. The paper also discusses the availability of the RAND-36 in multiple languages and summarizes changes that are incorporated in the latest version of the survey.

Are Latinos less satisfied with communication by health care providers

AbstractOBJECTIVE: To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white).n METHODS: A random sample of patients receiving medical care from a physician group association concentrated on the West Coast was studied. A total of 7,093 English and Spanish language questionnaires were returned for an overall response rate of 59%. Five questions asking patients to rate communication by their health care providers were examined in this study. All five questions were administered with a 7-point response scale.n MAIN RESULTS: We estimated the associations of satisfaction ratings with language (English vs Spanish) and ethnicity (white vs Latino) using ordinal logistic models, controlling for age and gender. Latinos responding in Spanish (Latino/Spanish) were significantly more dissatisfied compared with Latinos responding in English (Latino/English) and non-Latino whites responding in English (white) when asked about: (1) the medical staff listened to what they say (29% vs 17% vs 13% rated this “very poor,” “poor,” or “fair”; p<.01); (2) answers to their questions (27% vs 16% vs 12%; p<.01); (3) explanations about prescribed medications (22% vs 19% vs 14%; p<.01); (4) explanations about medical procedures and test results (36% vs 21% vs 17%; p<.01); and (5) reassurance and support from their doctors and the office staff (37% vs 23% vs 18%; p<.01).n CONCLUSION: This study documents that Latino/Spanish respondents are significantly more dissatisfied with provider communication than Latino/English and white respondents. These results suggest Spanish-speaking Latinos may be at increased risk of lower quality of care and poor health outcomes. Efforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.

Representativeness of the Patient-Reported Outcomes Measurement Information System Internet panel

OBJECTIVESnTo evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS), which collected data from an Internet polling panel, and to compare PROMIS with national norms.nnnSTUDY DESIGN AND SETTINGnWe compared demographics and self-rated health of the PROMIS general Internet sample (N=11,796) and one of its subsamples (n=2,196) selected to approximate the joint distribution of demographics from the 2000 U.S. Census, with three national surveys and U.S. Census data. The comparisons were conducted using equivalence testing with weights created for PROMIS by raking.nnnRESULTSnThe weighted PROMIS population and subsample had similar demographics compared with the 2000 U.S. Census, except that the subsample had a higher percentage of people with higher education than high school. Equivalence testing shows similarity between PROMIS general population and national norms with regard to body mass index, EQ-5D health index (EuroQol group defined descriptive system of health-related quality of life states consisting of five dimensions including mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and self-rating of general health.nnnCONCLUSIONnSelf-rated health of the PROMIS general population is similar to that of existing samples from the general U.S. population. The weighted PROMIS general population is more comparable to national norms than the unweighted population with regard to subject characteristics. The findings suggest that the representativeness of the Internet data is comparable to those from probability-based general population samples.

Adolescent participation in preventive health behaviors, physical activity, and nutrition : Differences across immigrant generations for asians and latinos compared with whites

OBJECTIVESnWe investigated preventive health behaviors (bicycle helmet, seat belt, and sunscreen use), physical activity, television viewing or video game playing, and nutrition (fruit, vegetable, milk, and soda consumption) among Asian and Latino adolescents living in the United States; assessed trends across generations (first-, second-, and third-generation immigrants or later); and compared each generation with White adolescents.nnnMETHODSnWe used data from 5801 adolescents aged 12 to 17 years in the representative 2001 California Health Interview Survey.nnnRESULTSnIn multivariate analysis, first-generation Asians measured worse than Whites for preventive health behaviors (lower participation), physical activity (less activity), and television viewing or video game playing (more hours), but improved across generations. For these same behaviors, Latinos were similar to or worse than Whites, and generally showed no improvement across generations. First-generation Asians and Latinos had healthier diets than Whites (higher fruit and vegetable consumption, lower soda consumption). With succeeding generations, Asians fruit, vegetable, and soda consumption remained stable, but Latinos fruit and vegetable consumption decreased and their soda consumption increased, so that by the third generation Latinos nutrition was poorer than Whites.nnnCONCLUSIONSnFor the health behaviors we examined, Asian adolescents health behaviors either improved with each generation or remained better than that of Whites. Latino adolescents demonstrated generally worse preventive health behaviors than did Whites and, in the case of nutrition, a worsening across generations. Targeted interventions may be needed to address behavioral disparities.

CROSSING THE BORDER FOR HEALTH CARE

A survey was administered to adults attending a health fair in south Los Angeles County, approximately 140 miles from the U.S.-Mexico border. The survey revealed that 14 percent of respondents had crossed the border to seek medical care during the past year. Nearly 80 percent of respondents crossing the border for medical care were uninsured, while 70 percent reported the low cost of medical care obtained across the border as being the most common reason for seeking care there. Twenty-eight percent of respondents reported purchasing medication in Mexico, with antibiotics and pain medication being reported in highest frequency. Ninety percent of these respondents were uninsured. This study shows that the high cost of health care and lack of insurance compels the poor and uninsured to seek low-cost health care and medication in Mexico to meet their most urgent health care needs, despite the burden of cost and travel.

Health Plan Effects on Patient Assessments of Medicaid Managed Care Among Racial/Ethnic Minorities

AbstractOBJECTIVE: To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to differential treatment by the same health plans (within-plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between-plan differences).n DESIGN: Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within-plan effects, and between-plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data.n PATIENTS/PARTICIPANTS: A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000.n MAIN RESULTS: Non-English speakers reported worse experiences compared to those of whites, while Asian non-English speakers had the lowest scores for most reports and ratings of care. An analysis of between-plan effects showed that African Americans, Hispanic-Spanish speakers, American Indian/Whites, and White-Other language were more likely than White-English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ethnic differences in CAHPS reports and ratings of care are attributable to within-plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating).n CONCLUSIONS: The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.

The Relationship Between Spanish Language Use and Substance Use Behaviors Among Latino Youth: A Social Network Approach

PURPOSEnGreater acculturation is associated with higher rates of substance use among Latino adolescents, but the reasons are poorly understood. One potential explanation is that social networks change with acculturation, leading to decreased protection and increased risk. Our objective was to identify Spanish language-sensitive individual and social network attributes associated with substance use in Latino adolescents.nnnMETHODSnLatino eighth-grade students in a Los Angeles public middle school completed a computerized, self-administered survey about tobacco, alcohol, drug use, and parental monitoring; and description of 30 social network members. Regression analyses were used to estimate the independent associations of network-level Spanish language use and other factors with a substance use behavior scale. Mediation analysis identified Spanish language-sensitive attributes.nnnRESULTSnNetwork-level Spanish language use was associated with a substance use scale in bivariate but not multivariate models. Protective Spanish language-sensitive attributes included greater numbers of extended family members in the network, less substance use among network members, and greater perceived parental monitoring. Risky Spanish language-insensitive attributes include more high school aged network members.nnnCONCLUSIONSnThese results suggest that parental monitoring and some characteristics of social networks account for the relationship between Spanish language use and substance use among Latino adolescents. Clinic- or community-based interventions that enhance protective characteristics of social networks in Latino adolescents may be effective.

Race/ethnicity, socioeconomic status, and satisfaction with health care.

The purpose of the present study was to evaluate the effects of race/ethnicity and socioeconomic status on consumer health care satisfaction ratings. The authors analyzed national data from the 2001 National Research Corporation Healthcare Market Guide Survey (N = 99 102). Four global and 3 composite ratings were examined. In general, satisfaction ratings were high across all global and composite measures; however, Asian/Pacific Islanders and Hispanics gave lower ratings than did whites, and African Americans gave a mix of higher and lower ratings (vs whites). Among the lowest ratings were those given by American Indians/Alaska Natives living in poverty. Race/ethnicity effects were independent of education and income. These findings are consistent with reports of continuing racial/ethnic disparities in both coverage and care. Programs to improve quality of care must specifically address these well-documented, severe, and persistent disparities.

Do Health Care Ratings Differ by Race or Ethnicity

BACKGROUNDnThere is growing evidence that Asians and Pacific Islanders perceive their health care more negatively than whites and other racial and ethnic subgroups. This study of differences in health care experiences by race and ethnicity was the first to use nationally representative data.nnnMETHODSnData from the 1998 National Research Corporation Healthcare Market Guide survey were analyzed. A total of 120,855 respondents were included in the study. Four global satisfaction ratings (overall health plan satisfaction, medical care satisfaction, recommend plan to others, and intent to switch plans) and four composite measures (access to care, providers delivery of care, customer service, and cost/benefits of care) were examined.nnnRESULTSnNonwhite survey respondents--particularly those in the other/multiracial and Asian/Pacific Islander groups--rated their health plan coverage and medical care lower than whites.nnnDISCUSSIONnThe results of this study are consistent with those of other recent (and comparable) studies in which these racial and ethnic groups are represented. Most strikingly consistent, however, are the lower ratings of Asians/Pacific Islanders and the comparable (and higher) ratings (compared to whites) of African Americans. Why Asians/Pacific Islanders are considerably less satisfied with their medical care than all other racial and ethnic groups in the United States needs to be explored. Access to care and quality of care improvement efforts should be directed at all ethnic minority groups, particularly for limited English-speaking, other/multiracial, Hispanic, and Asian/Pacific Islander subgroups.

Variation in the Readability of Items Within Surveys

The objective of this studywas to estimate the variation in the readability of survey items within 2 widely used health-related quality-of-life surveys: the National Eye Institute Visual Functioning Questionnaire–25 (VFQ-25) and the Short FormHealth Survey, version 2 (SF-36v2). Flesch-Kincaid and Flesch Reading Ease formulas were used to estimate readability. Individual survey item scores and descriptive statistics for each survey were calculated. Variation of individual item scores from the mean survey score was graphically depicted for each survey. The mean reading grade level and reading ease estimates for the VFQ-25 and SF-36v2 were 7.8 (fairly easy) and 6.4 (easy), respectively. Both surveys had notable variation in item readability; individual itemreadability scores ranged from 3.7 to 12.0 (very easy to difficult) for the VFQ-25 and 2.2 to 12.0 (very easy to difficult) for the SF-36v2. Because survey respondents may not comprehend items with readability scores that exceed their reading ability, estimating the readability of each survey item is an important component of evaluating survey readability. Standards for measuring the readability of surveys are needed.