Is hospital service associated with racial and ethnic disparities in experiences with hospital care?
OBJECTIVE
Little is known about the influence of processes of hospital care on racial and ethnic differences in experiences with hospital care.


METHODS
To determine whether patient experiences differed by race and ethnicity and whether these differences were associated with hospital care characteristics, we analyzed survey and hospital administrative data from 2664 adult patients after hospitalization at an urban teaching hospital during 1998-1999. We assessed the association of patient race and ethnicity with reporting problems in multiple dimensions of patient experience, using logistic regression to adjust for sex, age, self-reported health status, insurance status, income, route of hospital admission, and hospital service. We then stratified adjusted analyses by hospital service.


RESULTS
After adjustment for demographic and hospital characteristics, black (odds ratio (OR): 1.8; 95% confidence interval [CI]: 1.3-2.6) and Latino (OR: 2.0; 95% CI: 1.3-3.0) patients reported more problems with respect for their preferences compared to whites. Blacks reported more problems with respect for their preferences (OR: 1.7; 95% CI: 1.0-3.0) among patients discharged from surgical services, and Latinos reported more problems with respect for their preferences (OR:3.6; CI: 1.6-8.2) among patients discharged from obstetrical services when compared to whites. Patient experiences did not significantly differ by race among patients discharged from medical services.


CONCLUSIONS
We found significant racial and ethnic differences in patients' experiences with hospital care, particularly in respect for patient preferences. Our findings suggest physicians and hospital staff should strive to understand and address the expectations of black and Latino patients, particularly those who are hospitalized for surgical or obstetrical issues.
Hicks
LeRoi S
LS
Department of Medicine, Division of General Internal Medicine, Brigham and Women's-Faulkner Hospitalist Program, Brigham and Women's Hospital; Department of Health Care Policy, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Ayanian
John Z
JZ
Orav
E John
EJ
Soukup
Jane
J
McWilliams
J Michael
JM
Choi
Sharon S
SS
Johnson
Paula A
PA
D000328:Adult; D001741:Black or African American / Q000523:psychology; D001900:Boston; D018864:Cultural Diversity; D005260:Female; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000523:psychology; D006748:Hospital Departments / Q000592:standards; D015285:Hospital-Patient Relations; D006784:Hospitals, Teaching / Q000592:standards*; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000208:ethnology*; D017064:Process Assessment, Health Care; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data