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Myrick KL, Salvaggio M, Ejike-King L, et al. Planning, Development, Design, and Operation of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians [Internet]. Atlanta (GA): National Center for Health Statistics (NCHS); 2025 Jan.
Planning, Development, Design, and Operation of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians [Internet].
Show detailsIn the United States, people from various cultural backgrounds face persistent and well-documented health disparities (1). Biological and social determinants of health, such as poverty, low socioeconomic status, and lack of access to care, contribute to health disparities and poor health outcomes along racial and ethnic lines (2). The estimated financial burden of health disparities in the United States is $135 billion a year (3). As current and projected demographics shift in the United States toward growing racial, ethnic, and linguistic diversity (4), social justice and business philosophies are focused on how to achieve health equity and how to better serve diverse populations. It has been shown that one of the most modifiable factors in the delivery of health care is the lack of culturally and linguistically appropriate services (CLAS) (5,6).
With the release of the Institute of Medicine’s 2002 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” CLAS gained recognition as an important way to help address the persistent disparities among the nation’s diverse communities (1). CLAS refers to services that are a) respectful of, and responsive to, individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs; and b) used by all members of an organization (regardless of size) at every point of contact (7).
National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care
The U.S. Department of Health and Human Services (HHS) Office of Minority Health was created in 1986 as a result of the 1985 landmark report, “Report of the Secretary’s Task Force Report on Black & Minority Health” (8). The mission of the Office of Minority Health is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities (9). The Office of Minority Health developed the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, or National CLAS Standards, in 2000 (10) and revised them in 2013 (11). They are intended to advance health equity, improve healthcare quality, and help eliminate healthcare disparities by establishing a blueprint for people and healthcare organizations to implement culturally and linguistically appropriate healthcare services (5). The enhanced standards (Table A) are a comprehensive series of guidelines that inform, guide, and facilitate practices related to CLAS healthcare services. The Principal Standard (Standard 1) represents the overarching goal of the other 14 standards: “provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.” Supporting this central goal are the concepts of Governance, Leadership, and Workforce (Standards 2–4); Communication and Language Assistance (Standards 5–8); and Engagement, Continuous Improvement, and Accountability (Standards 9–15). By providing a structure to implement CLAS, the enhanced National CLAS Standards aim to improve an organization’s ability to address healthcare disparities (5).
Table A
Enhanced National CLAS Standards
Practices that have adopted National CLAS Standards have been shown to provide a supportive infrastructure for providers to promote CLAS through knowledge, skills, and behaviors during clinical encounters. Betancourt states that cross-cultural communication during patient–provider interactions can improve healthcare quality through more accurate diagnoses, prevention of unnecessary risks associated with procedures and medications, and participatory medical decision-making (12). Additionally, consideration of patients’ values and preferences during clinical encounters can result in more effective care (12,13).
National Ambulatory Medical Care Survey
The National Ambulatory Medical Care Survey (NAMCS) (see: https://www.cdc.gov/nchs/namcs/about/index.html) is a nationally representative survey of nonfederal, office-based physicians who are primarily engaged in patient care and who do not specialize in radiology, pathology, or anesthesiology (14). NAMCS is designed to provide objective, reliable information about the provision and use of ambulatory medical care services in the United States. It is conducted by the National Center for Health Statistics. In 2016, data was collected by computer-assisted personal interview. NAMCS had two components: the patient record form and the physician induction interview. The patient record form collected patient medical record information about a sample of patients during a randomly selected week. The physician induction interview collected information on physician and practice characteristics (available from: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/nchs/data/ahcd/2016_NAMCS_Traditional_Physician_Induction_Interview_Sample_Card.pdf). This included two questions about CLAS in data collection years 2015–2018.
National CLAS Physician Survey
The National Ambulatory Medical Care Survey Supplement for Culturally and Linguistically Appropriate Services for Office-based Physicians, subsequently referred to as the National CLAS Physician Survey, is a supplement of NAMCS. The National CLAS Physician Survey and NAMCS share the same eligibility criteria and sample frame (15). The National CLAS Physician Survey was funded by the Office of Minority Health.
Survey Objectives
Key objectives for the National CLAS Physician Survey were to describe the nature and extent of physician awareness, knowledge, and implementation of the National CLAS Standards and to identify factors that aided or prevented the provision of CLAS. Specifically, the following objectives guided the scope and content of the survey:
- What is the nature and extent of ambulatory care provider awareness and knowledge of the National CLAS Standards?
- What is the nature and extent of ambulatory care provider implementation of CLAS?
- What factors enable or hinder the provision of CLAS in ambulatory care settings?
- Introduction and Background - Planning, Development, Design, and Operation of th...Introduction and Background - Planning, Development, Design, and Operation of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians
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