Racial/ethnic minority and female patients in the United States often have worse healthcare outcomes when compared with white and male patients even when controlling for insurance status, education, and other socioeconomic factors. A growing body of research seeks to understand the contribution interpersonal and institutional bias to these observed inequities. However, efforts to further describe and reduce patient experiences of healthcare discrimination are limited by the lack of a standardized approach to capture this phenomenon. We now build upon our earlier work and seek to finalize and test an item bank, the Patient-Reported Experiences of Discrimination in Care Tool (PreDict), that can be used to assess the patient-centeredness of the care experience, to compare and report on hospital-level performance, and to ultimately improve the quality of care delivery within healthcare organizations. In this current application, we specifically propose to: 1) apply advanced statistical techniques to a set of candidate items after field testing them with a sample (n=6000) of patients recently discharged from twenty hospitals across the states of Connecticut, Virginia, and Colorado in order to determine the finalized item bank; 2) develop PreDict as a hospital-level assessment measure with application as a quality improvement tool; and 3) describe the relationship between hospital-level performance on PreDict items and other measures of hospital quality. The proposed work is the logical next step towards a standardized approach to data collection on patient experiences of healthcare discrimination. A systematic strategy towards the study of patient reports of discrimination across healthcare organizations remains necessary to expand the evidence base in this area and to inform effective interventions.
Existing research suggests that patient-reported racial/ethnic discrimination within healthcare settings contributes to persistent racial/ethnic disparities in health but a standard measurement approach to capture these experiences is lacking. Refining and calibrating the Patient-reported experiences of discrimination in care tool (PreDict) as a hospital-level performance measure is a critical step in reducing and eventually eliminating any contribution of healthcare discrimination to health disparities in the United States.
