Consumer Perception of Culturally Competent Outpatient Services & Hospital Use

Carol Carstens, PhD, LISW-SMeeting of the Ohio Community Support Planning CouncilColumbus, OhioSeptember 15, 2012

AbstractObjective: To look a the relationship between patient-reported perception of outpatient services and hospital use.

Data Source/Collection: Data were collected in a mail survey of minority consumers (N = 373).

Design/Methods: In this cross-sectional study, Likert-type scales were used to collect information on client perception of providers’ cultural competence. Forms were matched with administrative data on hospitalization during the study period. Logistic regression was used to examine the relationship between cultural competence and the independent variables.

Principal Findings: After controlling for subject-related factors, consumer perception of provider cultural competence was significantly related to likelihood

of hospitalization.

Conclusions: Cultural competence is a specific approach to patient centered care that can improve community tenure and reduce the likelihood of hospitalization.

Research Question

Does a consumer’s perception of his or her outpatient provider’s level of cultural competence have any association with hospitalization?

ODMH Definition

Cultural Competence is a continuous learning process that builds knowledge, awareness, skills and capacity to identify, understand and respect the unique beliefs, values, customs, languages, abilities and traditions of all Ohioans in order to develop policies to promote effective programs and services.

Why is Someone’s Cultural Perspective Important?

Culture falls under the umbrella of person-centered care. It provides a framework for understanding human experience:

Personal & Group Identity Beliefs & Values Customs & Traditions Language & History Otherness: Minority versus Majority

Devilish Little Detail

How do you measure a provider’s “knowledge, awareness, skills and capacity to identify, understand and respect” a consumer’s culture?

Very little research measures and evaluates the service providers’ cultural competence from the consumer perspective.

Consumer Based Cultural Competence Survey (CBCCS)

52-item Consumer-based Cultural Competence Inventory (CBCCI) developed by L.J. Cornelius & others in Maryland in 2002

20 items from CBCCI tested & analyzed by ODMH-ORE staff in Ohio administration in 2012

10 items from CBCC survey adopted to analyze risk of hospital service use

Conceptual and Statistical Considerations

Leading Question…

Some people belong to minority groups because their race, country of origin, history, language, religion, or sexual orientation is different than most people. Do you consider yourself a cultural, racial, ethnic, religious, or sexual minority group member?

Yes No

If you answered YES, what is your minority group? (Specify cultural, racial, ethnic, religious and/or sexual identity)____________________

Minority Status

About 37% of the sample who were people of color or of Hispanic ethnicity said No to the question about minority status.

The US is becoming more racially and ethnically diverse.

Many people in the sample do not appear to see themselves as “other” or set apart from mainstream society because of race or ethnicity.

How Much Do you Agree/Disagree?

Staff listen to me and my family when we talk to them.

Staff who work directly with me on my mental health needs respect my belief in God, a supreme being or higher power.

Some staff at my agency understand the difference between their culture and mine.

Staff understand that people of my racial or ethnic group are not all alike.

When I first called or came to the agency, it was easy to talk to the staff.

Continued…

Most of the time, I feel I can trust the staff who work with me.

Staff understand some of the different ideas that I, my family, and others from my minority group have about mental illness.

Staff are willing to be flexible and provide alternative approaches or services to my cultural/ethnic treatment needs.

The agency waiting room has pictures or reading material that show people from my minority group.

The agency’s reading materials and handouts are in other languages as well as English.

Sampling

Adult survey: 4,740 randomly selected adult consumers with serious mental illness (SMI)

Minority subsample: 1,325 consumers selected if race code indicated person of color – OR – ethnicity code indicated Hispanic origin

175 individuals selected where race = White without Hispanic qualifier

Total subsample = 37% of adult consumer sample received cultural competence questionnaire

Response

430 completed CBCC surveys returned

25% of total subsample

373 CBCC Surveys in Hospitalization Analysis

37 Cases with Hospitalization in past 18 months

Provider at time of Hospitalization = Provider at time

of Survey

334 Cases without Hospitalization

Medicaid and State Records

Who Participated?

9%

85%

6%Race

WhiteBlackOther

• 61% Female

• 39% Male

• 7% Hispanic

• 9% Religious Identity

• 2% LGBT Identity

• 1% Other

Logistic Regression

A statistical test that determines whethera low mean score on a scale like the CBCC

has an association with hospital use…

YES

NO

Controlling for Other Factors

After eliminating the possibility that

AgeRaceEthnicityGeographic LocaleDiagnosis

might better explain risk of hospitalization

Study Finding

The probability that the consumer stayed out of the hospital and remained in the community increased by

… with every 1 point increase in CBCC scale.

95% confident the statistic is accurate

40