Measuring Equity in the Hospital Setting

Background

Health care quality varies by patient factors, including race-and-ethnicity and preferred language. Addressing inequities requires identifying them and incentivizing equity.

Objectives

We apply an approach first implemented in the Medicare Advantage setting to measure equity in patient experiences by race-and-ethnicity [Asian American and Native Hawaiian or Pacific Islander (AA and NHPI), Black, Hispanic, vs. White] and language preference (English-preferring vs. another-language-preferring). We identify characteristics of hospitals providing high-quality equitable care.

Research Design

We estimated, standardized, and combined performance measures into a Health Equity Summary Score (HESS) using 2016-2019 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. The HCAHPS HESS considered current cross-sectional performance, within-hospital improvement, and overall improvement by race-and-ethnicity and language preference.

Subjects

A total of 3333 US hospitals with 2019 HCAHPS Star Ratings.

Results

The HCAHPS HESS was calculable for 44% of hospitals. High-scoring (4-5 diamonds on a 1-diamond to 5-diamond scale) hospitals tended to be smaller than intermediate-scoring [3 diamonds (14% of high-scoring hospitals had <100 beds vs. 7% of intermediate-scoring hospitals, P<0.001) and were less often for-profit (20% vs. 31%, P<0.001)]. While a significant percentage (29%) of patients served by high-scoring hospitals were AA and NHPI, Black, or Hispanic, and 9% were another-language-preferring, there were smaller proportions of Black and Hispanic patients in high-scoring versus other hospitals. HESS performance was negatively associated with the percentage of patients preferring another language to English. HESS scores were moderately correlated with overall Star Ratings (r=0.70).

Conclusions

The HCAHPS HESS and practices of high-scoring hospitals could promote more equitable patient experiences.