Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter.

K Viswanath,Kara Sewalk,David R Williams,John S Brownstein,S V Subramanian,Yulin Hswen,Jared B Hawkins,Gaurav Tuli

doi:10.2196/17048

Abstract

BackgroundRacial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys.ObjectiveThis study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016.MethodsIn total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014.ResultsRacial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White.ConclusionsThe ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

Highlights

In the United States, racial and ethnic minority populations experience suboptimal access to quality health care [1]
The Affordable Care Act (ACA) mandated the implementation of the measurement of patient experience of care delivery
Since patient experience is strongly associated with quality health care [2,3,4], lower quality health care within these groups may be attributed to poorer patient experiences

Summary

Introduction

In the United States, racial and ethnic minority populations experience suboptimal access to quality health care [1]. Since patient experience is strongly associated with quality health care [2,3,4], lower quality health care within these groups may be attributed to poorer patient experiences Because of these poorer experiences by racial and ethnic minorities, authentic patient experience can be difficult to capture in traditional health care research. Research suggests that levels of reported patient satisfaction with health care may be inflated due to high risks of response bias, especially among racial and ethnic minorities who have historically received poor treatment and care [13]. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys

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Conclusion