Demographic Factors Associated with Patient-Reported Outcome Measures in Pain Management

摘要

Background: Pain control is strongly correlated with the Hospital Consumer Assessment ofHealthcare Providers and Systems (HCAHPS) quality-of-care domains and overall hospital experience.Prior research implicates several factors in the variability of patients’ pain management satisfactionscores, including but not limited to racial diversity, ethnic diversity, gender, socioeconomic status,and other cultural factors.Objective: In this study, we examined responses to the HCAHPS survey in order to assess factorsassociated with patient-reported experiences of pain management.Study Design: The study design involved a retrospective analysis of patient survey responses.Setting: The research took place at a university-affiliated tertiary hospital.Methods: The study was conducted in a university-affiliated tertiary hospital. Records for adultpatients discharged between October 2015 and June 2017 were included. We obtained all patientresponses to the HCAHPS pain management questions. We then performed a systematic statisticalanalysis to evaluate interactions between demographic factor variables and responses to theHCAHPS pain management questions.Results: Between October 2015 and June 2017, 107,287 patients were discharged fromthe hospital. Of these, 13,026 of the respondents answered at least one of the HCAHPS painmanagement questions.Among HCAHPS pain-domain respondents, “Hispanic” and “Black or African American”respondents are more likely to report successful Pain Control when compared to “Not Hispanic”and “Caucasian/White,” respectively (odds ratios [ORs] 1.60, 1.22). Additionally, among women,“Black or African American” respondents are more likely to report positive Staff Helpfulness than“Caucasian/White” respondents (OR 1.38).However, we also identified corresponding associations among HCAHPS pain-question respondingand patient race/ethnicity: “Hispanic” and “Black/African American” patients were each less likelyto respond to the HCAHPS pain questions (ORs 2.03, 2.74).Limitations: The primary limitation to this study was nonresponse bias; nevertheless, this is likelyto be similar to bias experienced at other institutions. Additionally, this is a single institution study;however, given that the institution has a very large catchment area, we believe the results couldbe generalized to other settings.Conclusion: Response rates and responses to HCAHPS pain questions vary by race/ethnicityand sex. It appears likely that Hispanic and Black/African American patients underreport negativeexperiences. As HCAHPS surveys are used to inform decision-making within the US health caresystem, demographic biases in the survey data could lead to biases in care and resource allocation.