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. 2019 Nov;28(11):3117-3135.
doi: 10.1007/s11136-019-02250-5. Epub 2019 Jul 26.

Differential item functioning of the CAHPS® In-Center Hemodialysis Survey

Claude M Setodji  1 , John D Peipert  2 , Ron D Hays  3   4
Affiliations

Differential item functioning of the CAHPS® In-Center Hemodialysis Survey

Claude M Setodji et al. Qual Life Res. 2019 Nov.

Abstract

Purpose: End-stage renal disease patients' experience of care is an integral part of the assessment of the quality of the care provided at hemodialysis centers and is needed to promote patient choice, quality improvement, and accountability. The purpose of this study is to evaluate the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS®) survey and its equivalence in different age, gender, race, and education subgroups.

Methods: The ICH-CAHPS survey was administered to 1454 patients from 32 dialysis facilities. For the characteristics compared, the sample had 756 participants younger than 65 years old, 739 men, 516 Black, 567 White, and 970 with less than high school diploma. Three different patient experience constructs were studied including nephrologist's communication and caring, quality of care and operations, and providing information to patients. We used item response theory analysis to examine the possibility of differential item functioning (DIF) by patient age, gender, race, and education separately after controlling for the other DIF characteristics and additional confounding variables including survey mode, mental, and general health status as well as duration on dialysis.

Results: The three constructs studied were unidimensional and no major DIF was observed on the composites. Some non-equivalences were observed when confounders were not controlled for, suggesting that such covariates can be important factors in understanding the possibility of disparity in patients' experience.

Conclusions: The ICH-CAHPS is a promising survey to elicit hemodialysis patients' experience that has good psychometric properties and provides a standardized tool for assessing age, gender, race, or education disparity.

Keywords: CAHPS In-Center Hemodialysis (ICH) Survey; Differential item functioning; Health care disparities; Item response theory; Measurement equivalence; Patient experiences of care.

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Conflict of interest statement

Conflict of Interest: None of the authors have conflicts of interest to disclose.

Figures

Fig 1
Fig 1
Response curve for Gender on selected candidate items and TCC curve for quality of care and operations
Fig 2
Fig 2
Response curve for Age on selected items and TCC curve for communication
Fig 3
Fig 3
Response curve for Education on DIF items and TCC curve for quality of care and operations
Fig 4
Fig 4
Response curve for Race (Black vs White) on selected items and TCC curve for communication
See this image and copyright information in PMC

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