Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

Abstract

Importance: Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD). Objective: To examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities. Design, Setting, and Participants: This study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022. Exposure: Enrollment in a Medicare Shared Savings Program ACO. Main Outcomes and Measures: Six ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients' rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others. Results: The final sample included 568368 beneficiaries (347783 female patients [61.2%]; 38030 African American patients [6.69%], 6258 Asian patients [1.10%], 18231 Hispanic patients [3.21%], and 505849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = -1.05; 95% CI, -1.15 to -0.95; P