Racial Differences in Patient Care Experiences

A new study on the racial differences in patient experience revealed no major differences in terms of healthcare quality between blacks and whites. However, it was evident that within any given hospital black patients reported better experience than whites do, even if black patients were less likely to recommend hospitals.

Patient-reported experience is a critical part of measuring healthcare quality, but there is limited data on racial differences in patient experience. José F. Figueroa, MD, MPH, and colleagues at the Harvard T.H Chan School of Public Health, conducted this research by comparing blacks’ and whites’ responses on measures of overall hospital rating, communication, clinical processes, and hospital environment to evaluate differences between blacks’ and whites’ ratings of hospitals. The findings are published in Health Affairs.

Consumer Assessment

For the research, they used patient-level data obtained from the 2009 and 2010 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys of hospitals. Six composite measures (communication with physicians, communication with nurses, communication about medications, pain control, discharge process, and staff responsiveness) were recorded to evaluate 2 global measures related to patient experience:

• Overall rating of the hospital
• Whether or not the patient would recommend the hospital

Only patients who identified themselves as black or white were included. No Hispanics or minority groups were included.

Study Results

Out of the 4,365,175 respondents to the survey, 9.8% were blacks and 90.2% were whites. Compared with white patients, black patients were more likely to be younger than age 65, female, report their health status as fair or poor, and have been admitted for a medical reason, plus they were less likely to have graduated from high school.

When examined for the measures of clinical care, there were no significant differences in the responses between the blacks and whites. However, the researchers found:

• Blacks were slightly more likely than whites to rate hospitals best (66.9% vs 65.9%)
• Both races with at least some college were less likely to recommend hospitals, compared with patients with less education
• Across both the races, patients with poor health scored lower on all measures of patient experience, compared to patients with good health

In general, blacks reported more positive experiences—though by a small margin—than whites across all measures.

Conclusion

Patient-reported experience in healthcare is a crucial quality metric. Payers and policy makers are increasingly using this metric to hold hospitals accountable. One area of particular concern is racial disparities in patients’ experiences. In light of these racial disparities, increasing attention should be diverted to cultural competency training to improve care delivered to minority patients.

“Previous work has shown that distrust of the healthcare system is associated with lower rates of recommended disease prevention and treatment of acute and chronic illness, as well as worse health status,” the authors concluded. “It is critically important to understand both the extent to which black patients may have differences in experience with hospital care and how those differences might be addressed.”