Measuring racial/ethnic discrimination in healthcare settings

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DESCRIPTION (provided by applicant): Racial/ethnic minority patients in the United States typically have worse health outcomes when compared with their non-minority counterparts. Health and healthcare inequities across racial/ethnic groups persist despite taking into account important factors such as insurance coverage, patient health behaviors, level of education, and income or wealth. A growing body of evidence suggests that discrimination may play an important role in creating and sustaining differences in healthcare utilization and health outcomes. Several studies conclude that racial/ethnic minority patients are more likely to report discriminatory experiences when interacting within healthcare settings than non-minority patients. Although the existing research demonstrates that patient perceptions of discrimination within healthcare settings are common and relevant, the variation in measurement across studies highlights the need for a standard measurement of perceived discrimination from the patient perspective. We, therefore, conducted a series of in-person key informant interviews with a purposeful, racially/ethnically diverse sample of patients, healthcare providers, community leaders, and healthcare administrators across the state of Connecticut to characterize discrimination within healthcare settings. Our analyzed findings will ultimately inform the development of a patient questionnaire that can be used to assess patient-centered care, to compare and report on performance, and to ultimately improve the quality of care within healthcare organizations. In this application, we specifically propose to: 1) develop a comprehensive set of candidate items for the questionnaire based upon original qualitative data, expert panel evaluation, community-based panel input, extensive literature review, and cognitive interviews with community-dwelling participants across Connecticut; and 2) field test the items to assess preliminary quantitative characteristics of the items across our sample of recently-discharged patients from inpatient medicine services in Connecticut. The proposed work is the critical first step towards development of a standardized questionnaire. A systematic strategy towards the study of patient perceptions of discrimination across healthcare organizations is needed to expand the evidence base in this area and to inform effective interventions. PUBLIC HEALTH RELEVANCE: Existing research suggests that perceived racial/ethnic discrimination within healthcare settings contribute to persistent racial/ethnic disparities in health but there is wide variation in how perceived discrimination is measured. The development and testing of a comprehensive item pool is the essential groundwork towards creating a standardized measure of perceived healthcare discrimination, a critical step in reducing and eventually eliminating any contribution of healthcare discrimination to health disparities in the United States.