Cover: Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience?

Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience?

National Results from the HCAHPS Survey

Published in: Medical Care (2023). doi: 10.1097/MLR.0000000000001949

Posted on rand.org Nov 17, 2023

by Megan K. Beckett, Marc N. Elliott, Katrin Hambarsoomian, Loida Tamayo, William Lehrman, Denis Agniel, Meagan Khau, Elizabeth Goldstein, Laura Giordano, Judy H. Ng, et al.

Objective

Assess whether hospital characteristics associated with better patient experiences overall are also associated with smaller racial-and-ethnic disparities in inpatient experience.

Background

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.

Research Design

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.

Subjects

Inpatients discharged from 4,365 hospitals in 2021 who completed an HCAHPS survey (N=2,288,862).

Results

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.

Conclusions

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.

Research conducted by

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