In U.S. health care, the most commonly reported type of discrimination is racially based. Racial discrimination imposes a particular burden on Black patients, whose receipt of less appropriate care than white patients is associated with higher mortality.
Most health systems assess patient experience with surveys, but the questions do not ask about racism. A new study by LDI senior fellows Anish Agarwal, Raina Merchant, and Eugenia South, all of the Perelman School of Medicine (PSOM), David Asch of PSOM and the Wharton School, and colleagues, used text messaged-based surveys to assess patient emergency department experience, including the impact of race.
“Inequity—specifically across race—has led to significant disparities in patient care and outcomes that persist in health care,” says Agarwal. “We need to find ways to measure experiences of racism and address it. In our study, we used automated text messaging after visits to the emergency department to assess patient experience and the impact of race on care.”
What the study finds, according to Agarwal, is that “patients are willing to respond to text messages and talk about the intersection of racism and health care. Next, when asked, 1 in 10 Black patients note that their race negatively impacted their care. In contrast, fewer than 2 in 100 white patients reported that race had a negative effect on their care. Black patients reported that race most heavily affected quality of care, respect, and communication.”
Moving forward, Agarwal says the path to improving clinical care is to listen deeply to direct feedback. “Dismantling structural racism across society, and within health care, requires specific attention,” he says. “We currently do not have ways to directly address or even investigate this critical aspect of health care. Our study shines light on the nuanced challenges of asking necessary, direct questions related to racism using patient-experience surveys.”
This story is by Chris Tachibana. Read more at Penn LDI.
