Geographic context of black‐white disparities in Medicare CAHPS patient experience measures

Objective To examine whether black‐white patient experience disparities vary by geography and within‐county contextual factors. Data Sources 321 300 Medicare beneficiaries responding to the 2015‐2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data...

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Bibliographic Details
Published in:	Health services research 2019-02, Vol.54 (1), p.275-286
Main Authors:	Fenton, Anny T., Burkhart, Q, Weech‐Maldonado, Robert, Haviland, Amelia M., Dembosky, Jacob W., Shih, Regina, Wilson‐Frederick, Shondelle M., Gaillot, Sarah, Elliott, Marc N.
Format:	Article
Language:	eng
Subjects:	African Americans - statistics & numerical data Aged Analysis Beneficiaries California Census data Contextual factors Continental Population Groups - statistics & numerical data Design factors Ethnic Groups - statistics & numerical data European Continental Ancestry Group - statistics & numerical data Female Geography Government programs Health care Health care access Health care industry Health care services accessibility Health Care Surveys Health disparities Health Equity Health Services Accessibility health/socioeconomic causes of health Healthcare Disparities - ethnology Humans Male Measurement Medical personnel Medical research Medicare Medicine, Experimental Poverty Poverty Areas Quality of care quality of care/patient safety (measurement) Quality of Health Care Racial segregation racial/ethnic differences in health and health care Random effects Regression analysis Regression models Segregation Special Issue: Health Equity Surveys United States
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Summary:	Objective To examine whether black‐white patient experience disparities vary by geography and within‐county contextual factors. Data Sources 321 300 Medicare beneficiaries responding to the 2015‐2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several within‐county contextual factors. Study Design Mixed‐effects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiary‐level case‐mix adjustors. Principal Findings Black‐white disparities in patient experiences were smaller in counties with higher average patient experiences. Black‐white disparities in patient experiences were not associated with county‐level poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries’ level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation. Conclusions Efforts to reduce black‐white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low‐income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.
ISSN:	0017-9124 1475-6773