Disparities In Patient Experience Research Articles

Improving post-injury follow-up survey response: incorporating automated modalities

BackgroundIncorporating post-discharge data into trauma registries would allow for better research on patient outcomes, including disparities in outcomes. This pilot study tested a follow-up data collection process to be incorporated into existing trauma care systems, prioritizing low-cost automated response modalities.MethodsThis investigation was part of a larger study that consisted of two protocols with two distinct cohorts of participants who experienced traumatic injury. Participants in both protocols were asked to provide phone, email, text, and mail contact information to complete follow-up surveys assessing patient-reported outcomes six months after injury. To increase follow-up response rates between protocol 1 and protocol 2, the study team modified the contact procedures for the protocol 2 cohort. Frequency distributions were utilized to report the frequency of follow-up response modalities and overall response rates in both protocols.ResultsA total of 178 individuals responded to the 6-month follow-up survey: 88 in protocol 1 and 90 in protocol 2. After implementing new follow-up contact procedures in protocol 2 that relied more heavily on the use of automated modalities (e.g., email and text messages), the response rate increased by 17.9 percentage points. The primary response modality shifted from phone (72.7%) in protocol 1 to the combination of email (47.8%) and text (14.4%) in protocol 2.ConclusionsResults from this investigation suggest that follow-up data can feasibly be collected from trauma patients. Use of automated follow-up methods holds promise to expand longitudinal data in the national trauma registry and broaden the understanding of disparities in patient experiences.

How the CAHPS Clinician and Group Patient Experience Survey Data Have Been Used in Research: A Systematic Review.

Patient experience is a key aspect of care quality. The Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) survey measures experiences with ambulatory care providers to inform public reporting, pay-for-performance initiatives, interventions, patient choice of physicians/practices, and quality improvement. Since the survey's 2007 release, no systematic review of its use in research has been published. We reviewed English-language, peer-reviewed articles published since 2008 using CG-CAHPS survey data in the U.S. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Checklist for Analytical Cross-Sectional Studies. We examined 126 articles and included 52. Twenty-seven articles focused on general primary care, and the others focused on ambulatory specialty care. Of the 52 studies, 37 were cross-sectional, and the majority conducted patient-level regression analysis, controlling for patient characteristics. The most-used CAHPS measures were overall provider rating and the provider communication composite. CG-CAHPS data were primarily utilized to evaluate interventions (24 studies) and examine cross-sectional associations (21 studies) of site-level (eg, organizational climate), provider-level (physician empathy), and patient-level (medication adherence) factors with patient experience. Four studies reported disparities in patient experience. The widespread use of CG-CAHPS data implies the survey's value in measuring and improving care quality. Unlike facility or plan surveys, the CG-CAHPS survey was designed to allow attribution to medical groups and clinicians, which, as evidence shows, is its main strength. Policymakers, researchers, clinicians, and health care leaders can leverage CG-CAHPS data in quality improvement efforts and interventions supporting patient-centered care.

Evaluating virtual visits for contraceptive counseling: An exploratory study using the Person-Centered Contraceptive Counseling (PCCC) scale, a patient-reported outcome measure

ObjectivesTo describe patient-reported quality of care for virtual contraceptive counseling, using the four-item Person-Centered Contraception Counseling (PCCC) scale. Secondary analyses evaluated PCCC scores by patient subgroups. Study designFrom December 2021 to May 2022, we offered an anonymous web-based survey, to English and Spanish-speaking female patients 18 to 45 years old who had virtual visits through two Family Planning offices affiliated with Columbia University/New York Presbyterian Hospital in New York City. ResultsAmong 196 respondents, 133 (68%) respondents gave the top score. The proportion who gave the top PCCC score was higher for the faculty-based practice vs. community-based practice (62% vs. 38% respectively, p = 0.02), video vs. telephone (84% vs. 16% respectively, p = 0.01), and English vs. Spanish (86% vs. 14% respectively, p = 0.02); but did not differ for ethnicity (p = 0.34). ConclusionsPatient-perceived quality of contraceptive counseling in virtual visits was high, with some disparities seen in the subgroups. ImplicationsThis exploratory study about contraceptive counseling during virtual visits showed that 68% of survey respondents gave the top box PCCC score. Our work also suggests disparities in patient experiences based on several factors. Future work may expand on nuances of disparities and how these influence care.

Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience? National Results From the HCAHPS Survey.

Assess whether hospital characteristics associated with better patient experiences overall are also associated with smaller racial-and-ethnic disparities in inpatient experience. Hospitals that are smaller, non-profit, and serve high proportions of White patients tend to be high-performing overall, but it is not known whether these hospitals also have smaller racial-and-ethnic disparities in care. We used linear mixed-effect regression models to predict a summary measure that averaged eight Hospital CAHPS (HCAHPS) measures (Nurse Communication, Doctor Communication, Staff Responsiveness, Communication about Medicines, Discharge Information, Care Coordination, Hospital Cleanliness, and Quietness) from patient race-and-ethnicity, hospital characteristics (size, ownership, racial-and-ethnic patient-mix), and interactions of race-and-ethnicity with hospital characteristics. Inpatients discharged from 4,365 hospitals in 2021 who completed an HCAHPS survey ( N =2,288,862). While hospitals serving larger proportions of Black and Hispanic patients scored lower on all measures, racial-and-ethnic disparities were generally smaller for Black and Hispanic patients who received care from hospitals serving higher proportions of patients in their racial-and-ethnic group. Experiences overall were better in smaller and non-profit hospitals, but racial-and-ethnic differences were slightly larger. Large, for-profit hospitals and hospitals serving higher proportions of Black and Hispanic patients tend to be lower performing overall but have smaller disparities in patient experience. High-performing hospitals might look at low-performing hospitals for how to provide less disparate care whereas low-performing hospitals may look to high-performing hospitals for how to improve patient experience overall.

Racial and Ethnic Disparities in Patient Experience and Diabetes Self-Management Among Nonpregnant Women of Childbearing Age With Diabetes in the United States: A Scoping Review, 1990 to 2020

ObjectiveThis scoping review aimed to identify any empirical literature describing racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women (aged 18–49 years) of childbearing age with diabetes in the United States. MethodsThis scoping review followed the Arksey and O'Malley methodological framework. We used a comprehensive search strategy to identify articles published from 1990 to 2021 in PubMed, CINAHL, EMBASE, Web of Science, the Cochrane Library, and Proquest Digital Dissertation and Theses. Two independent reviewers used Covidence, a web-based review management software, to screen articles by title and abstract, and then by full-text articles based on inclusion and exclusion criteria. A third reviewer arbitrated any disagreements. ResultsOf the original 6,115 peer-reviewed studies identified, eight fit the eligibility criteria. In research on nonpregnant women of childbearing age in the United States, four studies investigated racial and ethnic disparities in patient experience, and seven of the eight eligible studies investigated racial and ethnic disparities in diabetes self-management outcomes. No eligible studies examining racial and ethnic variations in the association between patient experience and diabetes self-management were found. ConclusionsThis scoping review identified limited available studies examining racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women of childbearing age in the United States. Future studies should examine these relationships to fill the gap in research. These findings are relevant as the prevalence of diabetes is increasing worldwide and racially/ethnically minoritized women are disproportionately affected.

Patient Experience for Hispanic Older Adults Varies by Language Preference.

Hispanic people with Medicare report worse patient experiences than non-Hispanic White counterparts. However, little research examines how these disparities may vary by language preference (English/Spanish). Using Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data, assess whether 2014-2018 disparities in patient experiences for Hispanic people with Medicare vary by language preference. We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures by race/ethnicity/language preference (Hispanic Spanish-respondents; Hispanic Spanish-preferring English-respondents; Hispanic English-preferring respondents; and non-Hispanic White English-respondents). A total of 1,006,543 Hispanic and non-Hispanic White respondents to the Medicare 2014-2018 CAHPS surveys. There were disparities for all Hispanic groups relative to non-Hispanic White English-respondents. Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-8 points), getting needed care (-5 points), doctor communication (-2 points), and customer service (-1 point), but better experiences for flu immunization (+2 points). Similarly, Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic English-preferring respondents for getting care quickly (-4 points) and getting needed care (-2 points). Hispanic English-preferring respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-4 points), getting needed care (-3 points), doctor communication and customer service (-2 points each), but better experience for flu immunization (+2 points). Regardless of language preference, Hispanic people with Medicare experience disparities in patient care relative to non-Hispanic White English-preferring counterparts. Hispanic Spanish-preferring English-respondents report the worse experiences, followed by Hispanic English-preferring respondents. Hispanic Spanish-respondents experienced the least disparities of the three Hispanic language subgroups.

Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study.

To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality. A retrospective cohort study of lung cancer survivors > 65years old who completed a CAHPS survey > 6months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group. Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality. There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.

Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study.

To determine whether racial/ethnic differences in patient experiences with care, potentially leading to underutilization of necessary care, are associated with disparities in Gleason score at diagnosis. We used the SEER-CAHPS linked dataset to identify Medicare beneficiaries who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey prior to diagnosis of prostate cancer. Independent variables included aspects of patient experiences with care captured by CAHPS surveys. We conducted survey weighted multivariable multinomial logistic regression analyses, stratified by patient race/ethnicity, to estimate associations of CAHPS measures with Gleason score at diagnosis. Of the 4,245 patients with prostate cancer, most were non-Hispanic white (NHW) (77.6%), followed by non-Hispanic black (NHB) (8.4%), Hispanic (8.4%), and Asian (5.6%). Excellent experience with getting needed prescription drugs was associated with lower odds of Gleason scores of 7 and 8-10 in NHBs (7: OR = 0.19, 95% CI = 0.05-0.67; 8-10: OR = 0.04, 95% CI = 0.01-0.2) and lower odds of 8-10 in NHWs (OR = 0.61, 95% CI = 0.40-0.93). For NHBs, excellent primary physician ratings were associated with greater odds of a Gleason score of 8-10 (OR = 13.28, 95% CI = 1.53-115.21). Patient experiences with access to care and physician relationships may influence Gleason score in different ways for patients of different racial/ethnic groups. More research, including large observational studies with greater proportions of racial/ethnic minority patients, is necessary to understand these relationships and target interventions to overcome disparities and improve patient outcomes.

Home Health Agencies With More Socially Vulnerable Patients Have Lower Experience-of-Care Ratings

Little is known about the disparities in patient experience of home health (HH) care related to social vulnerability. This study examined the relationships of patient Medicare-Medicaid dual eligible status and race and ethnicity with patient experience of HH care. We analyzed national data from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS), Outcome and Assessment Information Set, Medicare claims and Area Health Resources File for 11,137 Medicare-certified HH agencies (HHA) that provided care for Medicare beneficiaries in 2017. Patient-reported experience of care star ratings (1-5) in HHCAHPS included 3 domains (professional care delivery, effective communication, and specific issues in direct patient care) with each dichotomized into high (4-5) and low (1-3) experience of care. The proportion of patients with dual eligibility and the proportion of racial/ethnic minorities were summarized at the HHA level. HHA with higher proportion of dual eligible patients were less likely to have high experience of care rating in professional care delivery (smallest Odds Ratio [OR]=0.514; 95% CI: 0.397, 0.665; p<0.001), effective communication (smallest OR=0.442, 95% CI: 0.336, 0.583; p<0.001), and specific direct care issues (smallest OR=0.697, 95% CI: 0.540, 0.899; p=0.006). HHA with higher proportion of racial/ethnic minorities were also less likely to have high patient experience of care rating across all three domains (smallest OR=0.265, 95% CI: 0.189, 0.370; p<0.001). Disparities in patient experience of HH care exist and they are associated with low income and racial/ethnic minority status, indicating substantial unmet needs among these socially vulnerable patients.

Understanding disparities in primary care patient experience.

To understand disparities in primary care patient experience. A serial cross-sectional study was conducted to understand disparities in patient experience at 2 time points (2014 and 2016). Disparities related to age, gender, neighbourhood income, and self-rated health were explored using 3 analytic approaches: stratification, logistic regression, and relative comparison across multiple demographic variables. A multisite family health team in Toronto, Ont. Patients in the family medicine practice who completed e-mail surveys in 2014 (n = 1171, 19% response rate) and 2016 (n = 1823, 15% response rate). Patient-reported access (timely access when sick, access after hours) and patient-centredness (opportunity to ask questions, involvement in care decisions, enough time with provider). Performance for all measures improved between 2014 and 2016, with the greatest absolute improvement seen in access after hours (61% in 2014; 75% in 2016). Patients residing in low-income neighbourhoods reported worse patient experiences than those in high-income neighbourhoods did, as did patients with poor versus excellent self-rated health, even after adjustment for other variables. For example, in 2016, 60% of patients residing in low-income neighbourhoods reported timely access when sick versus 70% in high-income neighbourhoods (adjusted odds ratio of 0.67, 95% CI 0.47 to 0.95); 60% of patients with poor or fair self-rated health reported timely access when sick versus 72% with excellent self-rated health (adjusted odds ratio of 0.54, 95% CI 0.35 to 0.84). Comparing across demographic groups, patients with excellent self-rated health and poor or fair self-rated health reported the best and worst experiences, respectively, for all measures. In 2016, the average disparity between subgroups was largest for access after hours. In this setting, patient experience was worse for patients in lower-income neighbourhoods and those with poor or fair self-rated health. Access after hours demonstrated the greatest overall absolute improvement but also the greatest widening of disparities.

Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis.

IntroductionEmpathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy.MethodsUsing a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity.ResultsEighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance.ConclusionThese data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity.Trial registrationRegistration (PROSPERO): CRD42019142809.

Racial/Ethnic Disparities in Patient Experiences With Health Care in Association With Earlier Stage at Colorectal Cancer Diagnosis: Findings From the SEER-CAHPS Data.

Racial/ethnic minorities are more likely to be diagnosed at a later stage of colorectal cancer (CRC). Therefore, our objective was to identify whether racial/ethnic differences in patient experiences (PE) with health care are associated with stage at CRC diagnosis. The authors used the National Cancer Institute Surveillance, Epidemiology and End Results registry data linked with the Consumer Assessment of Healthcare Providers and Systems to conduct a retrospective cohort analysis. They examined composite measures from surveys to assess 3 domains: patient-centeredness, timeliness, and realized access. Multivariable logistic regression was used to determine the association between PE with care and earlier stage at diagnosis. Of the 9211 patients, 31.1% non-Hispanic White, 27.2% non-Hispanic Black (NHB), 32.3% Hispanic, and 36.4% Asian were diagnosed with early stage cancer. Compared with non-Hispanic White patients, for the timeliness domain, Hispanic [β=-2.82; 95% confidence interval (CI), -5.42 to -0.39] and Asian (β=-6.65; 95% CI, -9.44 to -3.87) patients had significant lower adjusted mean score for getting care quickly. For the realized access domain, Asian (β=-5.78; 95% CI, -8.51 to -3.05) and NHB patients (β=-3.18; 95% CI, -5.50 to -0.87) had significantly lower adjusted mean score for getting needed prescription drugs compared with non-Hispanic White patients. Among NHB patients, a 5-Unit increase in getting needed care quickly was associated with higher odds of earlier CRC stage at diagnosis (odds ratio, 1.06; 95% CI, 1.01-1.10). There are racial/ethnic disparities in PE with timeliness and realized access to care preceding a CRC diagnosis. Among NHB patients, poor experiences with timeliness and realized access of care may be associated with later stage at diagnosis.

Adjustment of Patient Experience Surveys for How People Respond.

Patient surveys are the primary tool to measure patient experiences of care. Caution must be taken when analyzing these data, as responses can be influenced by factors that do not reflect the quality of care received. To provide a practical overview of adjusting patient experience survey results to address bias related to patient case-mix, extreme response tendency, and mode of survey administration. We discuss options for adjustment for biases in how people respond to patient experience surveys. Case-mix adjustment (CMA) aims to compare provider performance that would have been observed if all providers had treated the same set of patients by removing the effects of patient characteristics that vary across providers. Extreme response tendency can bias the measurement of the disparities in patient experiences even after typical CMAs, since differences in patients' use of extreme response options may affect patient experience scores when they have a skewed distribution. Survey mode may affect scores for the provider entity being evaluated (eg, hospital) more than CMA if survey mode differs at the provider level. It is best practice to evaluate known source of bias when analyzing patient experience surveys. Failure to adjust for patient case-mix, extreme response tendency, and survey mode in patient experience surveys may lead to erroneous comparisons of providers.

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

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.

Abstract 2025: Racial differences in lung cancer patient experiences with medical care and their association with cancer mortality: A SEER-CAHPS study

Abstract INTRODUCTION: Racial disparities in lung cancer mortality may be impacted by differences in patient experiences with care, an important quality of cancer care indicator. Therefore, the objectives of our study are to examine whether there are racial disparities in patient experiences with care among lung cancer patients and to determine whether these disparities are associated with mortality. MATERIALS AND METHODS: We used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS®) that links SEER cancer registry data with CAHPS surveys of Medicare beneficiaries. We identified individuals ≥65 years old who were diagnosed with lung cancer and completed a CAHPS survey at least six months after cancer diagnosis. We examined composite scores (through three domains of patient-centeredness, timeliness, and realized access) and global ratings of care. We conducted multivariable linear regression models to assess the association between race and patient composite and global ratings of care. Multivariable Cox proportional hazards models were used to determine the association between patient composite and global ratings and mortality after cancer diagnosis. RESULTS: This study consisted of 2,603 lung cancer patients. For black patients, a 1-unit increase in their ability to get all needed care (HR: 0.99, 95% CI 0.98-0.99) and care coordination (0.97, 0.94-0.99) was associated with lower risk of mortality. For Hispanic (0.85, 0.74-0.99), Asian (0.75, 0.61-0.92) and white (0.94, 0.88-0.99) patients, a 1-unit increase in their rating of their specialist was associated with lower risk of mortality. Asians reported lower adjusted mean scores with their ability to get care quickly (B: -4.25, 95% CI: -8.19, -0.31), get needed care (-7.06, (-10.51, -3.61)), get needed drugs (-9.06, (-13.04, -5.08)), and rating of their overall health care (-0.39 (-0.68, -0.1)) compared to non-Hispanic white patients. Similarly, Hispanics reported lower adjusted mean score with their ability to get needed care (-5.21, (-9.03, -1.39)). We did not observe differences in patient experiences with care for black patients compared to those of white patients. CONCLUSION: There are racial disparities in patient experiences of care among Medicare lung cancer patients, and these disparities contribute to lung cancer mortality in different ways. More research is needed to determine how medical care experiences in lung cancer patients can influence receipt of patient care and reduce risk of lung cancer mortality. Citation Format: Emily Chan, Elizabeth A. David, Megan Eguchi, Myles Cockburn, Albert J. Farias. Racial differences in lung cancer patient experiences with medical care and their association with cancer mortality: A SEER-CAHPS study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2025.

Investigation of Geographic and Macrolevel Variations in LGBTQ Patient Experiences: Longitudinal Social Media Analysis.

BackgroundDiscrimination in the health care system contributes to worse health outcomes among lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients.ObjectiveThe aim of this study is to examine disparities in patient experience among LGBTQ persons using social media data.MethodsWe collected patient experience data from Twitter from February 2013 to February 2017 in the United States. We compared the sentiment of patient experience tweets between Twitter users who self-identified as LGBTQ and non-LGBTQ. The effect of state-level partisan identity on patient experience sentiment and differences between LGBTQ users and non-LGBTQ users were analyzed.ResultsWe observed lower (more negative) patient experience sentiment among 13,689 LGBTQ users compared to 1,362,395 non-LGBTQ users. Increasing state-level liberal political identification was associated with higher patient experience sentiment among all users but had stronger effects for LGBTQ users.ConclusionsOur findings highlight that social media data can yield insights about patient experience for LGBTQ persons and suggest that a state-level sociopolitical environment influences patient experience for this group. Efforts are needed to reduce disparities in patient care for LGBTQ persons while taking into context the effect of the political climate on these inequities.

Abstract A129: Racial/ethnic disparities in patient experiences with health care and the association with earlier stage at colorectal cancer diagnosis: Findings from the SEER-CAHPS data

Abstract Background: Racial/ethnic minorities are more likely to be diagnosed at a later stage of colorectal cancer (CRC). Disparities in late-stage CRC diagnosis are partly attributed to socioeconomic inequalities, poor access to early detection screening and poor access to timely, high-quality diagnostic care. Although these findings are useful for identifying subgroups at high-risk for late-stage CRC diagnosis, few studies have focused on potentially modifiable factors at the patient, healthcare system and provider-level. Therefore, our objective was to identify whether racial/ethnic differences in patient experiences with healthcare are associated with stage at CRC diagnosis. Methods: We used the NCI Surveillance, Epidemiology and End Results (SEER) registry data linked with patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS surveys are administered to a random sample of Medicare beneficiaries on fee-for-service or Medicare advantage health plans by the Centers for Medicaid and Medicare Services. We conducted a retrospective cohort analysis of patients &amp;gt;64 years old diagnosed with colorectal cancer from 1997-2011 who completed a CAHPS survey prior to the date of their CRC diagnosis. We examined the composite measures from CAHPS survey to assess patient experiences with care which we categorized into three domains: 1) patient-centeredness, 2) timeliness, and 3) realized access. Race/ethnicity was assessed using a self-reported measure from the CAHPS survey. We used multivariable linear regression to examine racial/ethnic differences in patient experiences with care for each domain controlling for sociodemographic and health characteristics. We ran a multivariable logistic regression model to determine the association between patient experiences with care and earlier stage (stage 0 and 1) at diagnosis. Results: Of the 9,211 patients, 79.7% were non-Hispanic white, 7.7% black, 7.4% Hispanic, and 5.2% Asian. After controlling for potential confounders, for the timeliness of care domain, Asian patients had significantly lower adjusted mean scores for getting care quickly (B=-6.65, 95% CI: -9.44, -3.87) compared to white patients. While for the realized access domain, Asian and non-Hispanic black patients had significantly lower adjusted mean scores for getting needed prescription drugs, B=-5.78 (95% CI: -8.51, -3.05) and B=-3.18 (95% CI: -5.50, -0.87), respectively. More importantly, we found that black patients who reported a 5-unit increase in rating of their experiences with getting needed care quickly (OR: 1.06, 95% CI: 1.01-1.10) had higher odds of being diagnosed at an earlier stage of colorectal cancer. Conclusion: There are racial/ethnic disparities in patient experiences with timeliness of and realized access to care preceding a diagnosis of colorectal cancer. Our study suggests that among black patients, poor experiences with timeliness of care may be associated with later stage at diagnosis. Citation Format: Carol Y Ochoa, Gabriela Toledo, Albert J Farias. Racial/ethnic disparities in patient experiences with health care and the association with earlier stage at colorectal cancer diagnosis: Findings from the SEER-CAHPS data [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A129.

Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis

IntroductionClinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities...

Substance Use Disorder-Related Disparities in Patient Experiences of Primary Care.

Purpose: To assess disparities in primary care experiences for patients with a substance use disorder (SUD) diagnosis.Methods: We assessed differences in Veterans Health Administration (VA) primary care patients' experiences using data from the 2014 outpatient VA Patient-Centered Medical Home Survey of Healthcare Experiences of Patients (SHEP; N=286,026). We obtained patient demographics and diagnoses from VA electronic medical record data.Results: Patients with an SUD diagnosis reported worse experiences for 8 of 12 SHEP measures, including access, provider communication, and information received (p<0.05).Conclusion: Targeted strategies may be needed to ensure patients with SUD have favorable primary care experiences.

Geographic context of black-white disparities in Medicare CAHPS patient experience measures.

ObjectiveTo examine whether black‐white patient experience disparities vary by geography and within‐county contextual factors.Data Sources321 300 Medicare beneficiaries responding to the 2015‐2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several within‐county contextual factors.Study DesignMixed‐effects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiary‐level case‐mix adjustors.Principal FindingsBlack‐white disparities in patient experiences were smaller in counties with higher average patient experiences. Black‐white disparities in patient experiences were not associated with county‐level poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries’ level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation.ConclusionsEfforts to reduce black‐white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low‐income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.