Journal of General Internal Medicine

, Volume 23, Issue 8, pp 1234–1240

Experiences with Hospital Care: Perspectives of Black and Hispanic Patients

  • LeRoi S. Hicks
  • Dora A. Tovar
  • E. John Orav
  • Paula A. Johnson
Populations at Risk

Abstract

BACKGROUND

Significant racial and ethnic differences along several dimensions of patients’experiences with hospital care have been previously documented. However, the relationship between these differences and possible differences in processes of care has not been well described.

METHODS

We conducted focus groups with 37 black and Hispanic men and women who had recently been discharged from either medical or obstetrical services at an urban academic medical center to assess which dimensions of these patients’ experiences with care were most important in determining overall levels of satisfaction.

RESULTS

Differences were found between Hispanics and blacks in the factors that influence their overall positive and negative experiences. Participants identified two themes that influence experiences with hospital care that are not commonly examined in many patient satisfaction instruments: availability and quality of translators, and attitudes of social workers and nursing staff.

CONCLUSIONS

Our findings suggest that hospitals should pursue hiring a culturally diverse work force and should collect racial and ethnically specific data about satisfaction with care including satisfaction with availability of social workers and interpreters.

KEY WORDS

race patient satisfaction focus groups 

References

  1. 1.
    Eisenberg JM. Sociologic influences on decision-making by clinicians. Ann Intern Med. 1979;90:957–64.PubMedGoogle Scholar
  2. 2.
    Levy DR. White doctors and black patients: influence of race on the doctor–patient relationship. Pediatrics. 1985;75:639–43.PubMedGoogle Scholar
  3. 3.
    Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273:1515–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282:583–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Ngo-Metzger Q, Legedza AT, Phillips RS. Asian Americans’ reports of their health care experiences. Results of a national survey. J Gen Intern Med. 2004;19:111–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Barr DA. Race/Ethnicity and patient satisfaction. Using the appropriate method to test for perceived differences in care. J Gen Intern Med. 2004;19:937–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Silverman M, Lave J, Musa D, et al. Medicare HMOs: the experience of older African Americans and whites. J Health Soc Policy. 2000;12:1–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Murray-Garcia JL, Selby JV, Schmittdiel J, et al. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Morales LS, Reise SP, Hays RD. Evaluating the equivalence of health care ratings by whites and Hispanics. Med Care. 2000;38:517–27.PubMedCrossRefGoogle Scholar
  10. 10.
    LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57Suppl 1146–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Doescher MP, Saver BG, Franks P, et al. Racial and ethnic disparities in perceptions of physician style and trust. Arch of Fam Med. 2000;9:1156–63.CrossRefGoogle Scholar
  12. 12.
    Carlson MJ, Blustein J, Fiorentino N, et al. Socioeconomic status and dissatisfaction among HMO enrollees. Med Care. 2000;38:508–16.PubMedCrossRefGoogle Scholar
  13. 13.
    Morales LS, Cunningham WE, Brown JA, et al. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14:409–17.PubMedCrossRefGoogle Scholar
  14. 14.
    Dayton E, Zhan C, Sangl J, Darby C, Moy E. Racial and ethnic differences in patient assessments of interactions with providers: disparities or measurement biases? Am J Med Qual. 2006;21:109–14.PubMedCrossRefGoogle Scholar
  15. 15.
    Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: National Academy Pr; 2003.Google Scholar
  16. 16.
    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Pr; 2001.Google Scholar
  17. 17.
    Withrow SC. The 8 dimensions of quality. Healthc Financ Manage. 2006;60:86–91.PubMedGoogle Scholar
  18. 18.
    Young GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Med Care. 2000;38:325–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Tucker JL 3rd, Kelley VA. The influence of patient sociodemographic characteristics on patient satisfaction. Military Med. 2000;165:72–6.Google Scholar
  20. 20.
    Hicks LSm, Ayanian JZ, Orav EJ, et al. Is hospital service associated with racial and ethnic disparities in experiences with hospital care? Am J Med. 2005;118:529–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Aff (Millwood). 1991;10:254–67.CrossRefGoogle Scholar
  22. 22.
    Gibbs GR. Qualitative Data Analysis: Explorations with NVivo. New York: Open University Press; 2004.Google Scholar
  23. 23.
    QRS. NVivo7, Version 7, Computer Software. Qualitative Research Solutions International, Australia; 2006.Google Scholar
  24. 24.
    Richards L. Using NVivo in Qualitative Research. Sage: London and Thousand Oaks; 1999.Google Scholar
  25. 25.
    Sharps PW, El-Mohandes AA, Nabel El-Khorazaty M, et al. Health beliefs and parenting attitudes influence breastfeeding patterns among low-income African-American women. J Perinatol. 2003;23:411–9.CrossRefGoogle Scholar
  26. 26.
    Carrasquillo O, Orav EJ, Brennan TA, et al. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14:82–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson KO, Mendoza TR, Valero V, et al. Minority cancer patients and their providers: pain management attitudes and practice. Cancer. 2000;88:1929–38.PubMedCrossRefGoogle Scholar
  28. 28.
    Hostetler MA, Auinger P, Szilagyi PG. Parenteral analgesic and sedative use among ED patients in the United States: combined results from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1992–1997. Am J of Emergency Med. 2002;20:139–43. Erratum in: Am J Emerg Med. 2002;20:496.CrossRefGoogle Scholar
  29. 29.
    Woodard LD, Hernandez MT, Lees E, Peterson LA. Racial differences in attitudes regarding cardiovascular disease prevention and treatment: a qualitative study. Patient Educ Couns. 2005;57:225–31.PubMedCrossRefGoogle Scholar
  30. 30.
    Benkert R, Peters R. African American women’s coping with health care prejudice. West J Nurs Res. 2005;27:863–889.PubMedCrossRefGoogle Scholar
  31. 31.
    Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care: perspectives of Chinese and Vietnamese Immigrants. J Gen Intern Med. 2003;18:44–52. Jan.PubMedCrossRefGoogle Scholar
  32. 32.
    Riddick S. Improving access for limited English-speaking consumers: a review of strategies in health care settings. JHCPU. 1998;9:S40–61.Google Scholar
  33. 33.
    Barr JK, Giannotti TE, Sofaer S, Duquette CE, Waters WJ, Petrillo MK. Using public reports of patient satisfaction for hospital quality improvement. Health Serv Res. 2006;41:663–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Health Research and Educational Trust. HRET Disparities Toolkit: a toolkit for collecting race, ethnicity, and primary language information for patients. Available at: https://secure.serve.com/disparities//Howt-4141.php. Accessed September 20, 2007.

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • LeRoi S. Hicks
    • 1
    • 2
    • 4
    • 5
  • Dora A. Tovar
    • 3
  • E. John Orav
    • 1
  • Paula A. Johnson
    • 1
    • 3
  1. 1.Department of Medicine, Division of General Internal MedicineHarvard Medical SchoolBostonUSA
  2. 2.Brigham and Women’s-Faulkner Hospitalist ProgramHarvard Medical SchoolBostonUSA
  3. 3.Division of Women’s Health, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  5. 5.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA

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