Consistency in Self-Reported Race-and-Ethnicity Over Time: Implications for Improving the Accuracy of Imputations and Making the Best Use of Self-Report.

Background: Medicare Bayesian Improved Surname and Geocoding (MBISG), which augments an imperfect race-and-ethnicity administrative variable to estimate probabilities that people would self-identify as being in each of 6 mutually exclusive racial-and-ethnic groups, performs very well for Asian American and Native Hawaiian/Pacific Islander (AA&NHPI), Black, Hispanic, and White race-and-ethnicity, somewhat less well for American Indian/Alaska Native (AI/AN), and much less well for Multiracial race-and-ethnicity.

Objectives: To assess whether temporal inconsistency of self-reported race-and-ethnicity might limit improvements in approaches like MBISG.

Methods: Using the Medicare Health Outcomes Survey (HOS) baseline (2013-2018) and 2-year follow-up data (2015-2020), we evaluate the consistency of self-reported race-and-ethnicity coded 2 ways: the 6 mutually exclusive MBISG categories and individual endorsements of each racial-and-ethnic group.

Comparison of Alternative Approaches to Using Race-and-Ethnicity Data in Estimating Differences in Health Care and Social Determinants of Health.

Objective: The objective of this study was to compare 2 approaches for representing self-reported race-and-ethnicity, additive modeling (AM), in which every race or ethnicity a person endorses counts toward measurement of that category, and a commonly used mutually exclusive categorization (MEC) approach. The benchmark was a gold-standard, but often impractical approach that analyzes all combinations of race-and-ethnicity as distinct groups.

Methods: Data came from 313,739 respondents to the 2021 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys who self-reported race-and-ethnicity.

Inpatient Care Experiences Differ for VA and Non-VA Hospitals, With Different Patterns by Health, Race, and Ethnicity.

This article estimates differences and difference-in-differences in patient experiences for Veterans Health Administration (VA) compared to non-VA patients in 2017, when there was concern about the health quality of VA hospitals, and in 2021, the second year of the COVID-19 pandemic, both overall, and for specific patient groups. We used data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In 2017, HCAHPS performance was somewhat better for non-VA than for VA hospitals, with Care Transition being the only measure for which VA hospitals performed better on average.

Mixed Mode Substantially Increases Hospital Consumer Assessment of Healthcare Providers and Systems Response Rates Relative to Single-Mode Protocols.

Background: Low response rates (RRs) can affect hospitals' data collection costs for patient experience surveys and value-based purchasing eligibility. Most hospitals use single-mode approaches, even though sequential mixed mode (MM) yields higher RRs and perhaps better patient representativeness. Some hospitals may be reluctant to incur MM's potential additional cost and complexity without knowing how much RRs would increase.

Medicare Advantage enrollees' reports of unfair treatment during health care encounters.

We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated whether they were treated unfairly in a health care setting based on any of 10 personal characteristics. We calculated reported unfair treatment rates overall and by enrollee characteristics. Nine percent of respondents reported any unfair treatment, most often based on health condition (6%), disability (3%), or age (2%).

Trends in HCAHPS Survey Scores, 2008-2019: A Quality Improvement Perspective.

Background: HCAHPS' 2008 initial public reporting, 2012 inclusion in the Hospital Value-Based Purchasing Program (HVBP), and 2015 inclusion in Hospital Star Ratings were intended to improve patient experiences.

Objectives: Characterize pre-COVID-19 (2008-2019) trends in hospital consumer assessment of healthcare providers and systems (HCAHPS) scores.

Research Design: Describe HCAHPS score trends overall, by phase: (1) initial public reporting period (2008-2013), (2) first 2 years of HVBP (2013-2015), and (3) initial HCAHPS Star Ratings reporting (2015-2019); and by hospital characteristics (HCAHPS decile, ownership, size, teaching affiliation, and urban/rural).

Survey Protocols, Response Rates, and Representation of Underserved Patients: A Randomized Clinical Trial.

Importance: Surveys often underrepresent certain patients, such as underserved patients. Methods that improve their response rates (RRs) would help patient surveys better represent their experiences and assess equity and equity-targeted quality improvement efforts.

Objective: To estimate the effect of adding an initial web mode to existing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey protocols and extending the fielding period on RR and representativeness of underserved patient groups.

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence.

Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions.

Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience? National Results From the HCAHPS Survey.

Objective: Assess whether hospital characteristics associated with better patient experiences overall are also associated with smaller racial-and-ethnic disparities in inpatient experience.

Background: Hospitals that are smaller, non-profit, and serve high proportions of White patients tend to be high-performing overall, but it is not known whether these hospitals also have smaller racial-and-ethnic disparities in care.

Research Design: We used linear mixed-effect regression models to predict a summary measure that averaged eight Hospital CAHPS (HCAHPS) measures (Nurse Communication, Doctor Communication, Staff Responsiveness, Communication about Medicines, Discharge Information, Care Coordination, Hospital Cleanliness, and Quietness) from patient race-and-ethnicity, hospital characteristics (size, ownership, racial-and-ethnic patient-mix), and interactions of race-and-ethnicity with hospital characteristics.

Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic.

Importance: It is important to assess how the COVID-19 pandemic was adversely associated with patients' care experiences.

Objective: To describe differences in 2020 to 2021 patient experiences from what would have been expected from prepandemic (2018-2019) trends and assess correlates of changes across hospitals.

Design, Setting, And Participants: This cohort study compared 2020 to 2021 data with 2018 to 2019 data from 3 900 887 HCAHPS respondents discharged from 3381 HCAHPS-participating US hospitals.

Development of a Medicare plan dashboard to promote health equity.

Objective: To describe a multistage process of designing and evaluating a dashboard that presents data on how equitably health plans provide care for their members.

Study Design: We designed a dashboard for presenting summative and finer-grained data to health plans for characterizing how well plans are serving individuals who belong to racial/ethnic minority groups and individuals with low income. The data presented in the dashboard were based on CMS' Health Equity Summary Score (HESS) for Medicare Advantage plans.

Measuring Equity in the Hospital Setting: An HCAHPS Application of the Health Equity Summary Score.

Background: Health care quality varies by patient factors, including race-and-ethnicity and preferred language. Addressing inequities requires identifying them and incentivizing equity.

Objectives: We apply an approach first implemented in the Medicare Advantage setting to measure equity in patient experiences by race-and-ethnicity [Asian American and Native Hawaiian or Pacific Islander (AA and NHPI), Black, Hispanic, vs.

The hospital care experiences of older patients compared to younger patients.

Background: Hospitals may provide less positive patient experiences for older than younger patients.

Methods: We used 2019 HCAHPS data from 4358 hospitals to compare patient-mix adjusted HCAHPS Survey scores for 19 experience of care items for patients ages 75+ versus 55-74 years and tested for interactions of age group with patient and hospital characteristics. We contrasted the age patterns observed for inpatient experiences with those among respondents to the 2019 Medicare CAHPS (MCAHPS) Survey of overall experience.

Community-dwelling adults with functional limitations are at greater risk for sleep disturbances.

Objective: To evaluate whether sleep disturbances vary along a continuum of functional limitations in a large nationally representative sample of US adults.

Methods: Using 2014-2015 National Health Interview Survey data (n = 33,424), we considered associations between each of 5 sleep disturbance measures (duration, trouble falling asleep, trouble staying asleep, use of sleep medications, waking rested) and Functional Limitations Index score, which distinguishes among adults with little-or-no (least-limited), moderate (somewhat-limited), and high functional limitations (most-limited).

Results: Somewhat-limited and most-limited respondents reported significantly worse sleep health for all sleep disturbance measures than people with little-or-no limitations, even controlling for body mass index, psychological distress, and 14 health indicators.

Distinguishing neighborhood and individual social risk factors in health care.

Objective: To investigate (a) the magnitude of the independent associations of neighborhood-level and person-level social risk factors (SRFs) with quality, (b) whether neighborhood-level SRF associations may be proxies for person-level SRF associations, and (c) how the association of person-level SRFs and quality varies by neighborhood-level SRFs.

Data Sources: 2015-2016 Medicare Advantage HEDIS data, Medicare beneficiary administrative data, and 2016 American Community Survey (ACS).

Study Design: Mixed effects linear regression models (1) estimated overall inequities by neighborhood-level and person-level SRFs, (2) compared neighborhood-level associations to person-level associations, and (3) tested the interactions of person-level SRFs with corresponding neighborhood-level SRFs.

Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures.

Background: Prior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices.

Objective: Estimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals.

Design: Mixed-effect regression models in cross-sectional data.

The development of a patient-reported functional limitations index.

Objectives: To develop an easy-to-interpret, patient-reported Functional Limitations Index (FLI) that can be used to assess and monitor the full spectrum of functioning in a community-dwelling population.

Study Design: Observational design using nationally representative survey data.

Methods: We used self-rated health as a criterion for empirically assigning weights to 5 National Health Interview Survey items assessing difficulty with seeing, hearing, walking, cognition, and self-care.

Associations of Mail Survey Length and Layout With Response Rates.

We assess the association between survey layout and response rates (RRs) in the 2017 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems mail survey. Among 438 Medicare Advantage plans surveyed by six vendors, there was latitude in survey layout, and plans could add up to 12 supplemental items. Regression models predicted survey response from survey characteristics (page count, number of supplemental items, and survey attractiveness), and beneficiary sociodemographics.

Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score.

Background: Social risk factors (SRFs) such as minority race-and-ethnicity or low income are associated with quality-of-care, health, and healthcare outcomes. Organizations might prioritize improving care for easier-to-treat groups over those with SRFs, but measuring, reporting, and further incentivizing quality-of-care for SRF groups may improve their care.

Objective: To develop, as a proof-of-concept, a Health Equity Summary Score (HESS): a succinct, easy-to-understand score that could be used to promote high-quality care to those with SRFs in Medicare Advantage (MA) health plans, which provide care for almost twenty million older and disabled Americans and collect extensive quality measure and SRF data.

Using Ancillary Sociodemographic Data to Identify Sexual Minority Adults Among Those Responding "Something Else" or "Don't Know" to Sexual Orientation Questions.

Background: General population surveys are increasingly offering broader response options for questions on sexual orientation-for example, not only gay or lesbian, but also "something else" (SE) and "don't know" (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories.

The effects of survey version on patient experience scores and plan rankings.

Objective: To assess the effect of changing survey questions on plan-level patient experience measures and ratings.

Data Source: 2015 Medicare Advantage CAHPS Survey respondents.

Study Design: Ninety three randomly selected beneficiaries in each of 40 MA plans received a revised (5.

An Integrated Approach to Measuring Sexual Orientation Disparities in Women's Access to Health Services: A National Health Interview Survey Application.

Purpose: The extent to which disparities affect all sexual minority women (SMW) versus specific subgroups of lesbian, bisexual, or other women remains unclear, in part due to inconsistent analysis of available data. We propose an integrated approach that aggregates subgroups to maximize power to detect broadly applicable disparities, then tests for subgroup heterogeneity, exercising caution with disaggregation when there is no direct evidence of heterogeneity.

Methods: Multivariate analyses of 2014-2015 National Health Interview Survey data examined six barriers to care.

Using predicted Spanish preference to target bilingual mailings in a mail survey with telephone follow-up.

Objective: Spanish-preferring Medicare beneficiaries are underrepresented in national patient experience surveys. We test a method for improving their representation via higher response rates.

Data Sources/study Setting: 2009-2010 Medicare CAHPS surveys; Medicare population.