It’s Time to Better Understand and Address Disparities in Patient Experiences

By Barbra G. Rabson

(July 2022) 

The pandemic has shown us that we are not doing enough to equally promote health for people of all races and ethnicities. Given that there are well-known and researched disparities across all aspects of care, it may not surprise you to learn that Black, Hispanic and Asian patients report less favorable patient experiences than White patients.

We recently analyzed the 2018 and 2019 results of MHQP’s statewide patient experience survey and found statistically significant differences in the primary care experiences reported by Black, Hispanic and Asian patients versus White patients. People identifying as Black or Hispanic consistently reported patient experience scores that were 3-4 points lower than White patients. People identifying as Asian consistently reported scores that were 6-8 points lower than White patients. And this was prior to stressors of the COVID pandemic hitting both patients and primary care practices.

These results are consistent with national studies and also with work MHQP had done on disparities in pain care, so I was saddened but not surprised by these findings.

These disparities are clearly unacceptable. What upsets me most is that primary care is the front door to the healthcare system and the place where patients are most likely to have a personal/trusting relationship with a provider. If these disparities in experiences are pervasive in primary care, it does not bode well for the rest of the system.

We need to come together and do something about it. This will not be easy, but we must do everything we can to address this issue.

The first thing we need to do is to fully understand the reasons for the differences in responses. There are many important questions that must be answered. Among them:

• In our analysis, we also found that Black, Hispanic and Asian respondents had shorter tenures with a Primary Care Physician (PCP) than White patients. Is this because Black, Hispanic and Asian patients switch PCPs more frequently as they cannot find one that meets their needs? Or do these patients tend to go to practices that have greater provider turnover? To what extent does this help explain the differences in experiences?
• Researchers have documented that different cultures have different “rating tendencies.” For example, in general, people of Asian descent tend to avoid extreme responses. How much of these results are explained by “rating tendencies” vs. actual experiential differences?
• Patient populations vary significantly across organizations. How can we account for these differences while fairly comparing inequities in patient experience across systems?

We would address the problem differently depending on the answers to these and other questions.

The next thing we need to do is to develop a shared measurement system. Achieving widespread change in patient experience and in other clinical areas related to health equity starts with a shared perspective on the problem, and this can only be accomplished through collaborative action. I am well aware of the fabulous health equity initiatives taking place within organizations throughout the state and these should absolutely continue. But I learned early on from health equity experts that meaningful, large-scale change to reduce inequities will only happen if we work together across systems and across stakeholder groups to create a path forward. This will include:

• Implementing a single standardized measurement to enable apples-to-apples comparisons;
• Establishing fair health equity measurement principles and methodology that will allow for reliable and comparable results that can be used across payers and providers for high stakes use; and
• Creating a statewide learning collaborative focused on improving inequities in patients’ experiences of care.

As we have been in the past, Massachusetts can and should be a leader for the nation at this pivotal point in our history. We at MHQP feel strongly that we must forge ahead to develop a deeper understanding of the facts and issues behind these disparities – and then begin to take proactive steps to address them. We need partners committed to changing these unsurprising, regrettable and fixable disparities and willing to work with us to improve our patients’ healthcare experiences.

Please reach out to me at brabson@mhqp.org if you would like to get involved or learn more. Thank you.