118. How Are We Doing? Examining the Patient Experience in Our Clinic Through an Equity Lens


      A patient’s experience in clinic can be impacted by their multiple identities as well as their lived experiences. At our institution, hospital-wide surveys tend to over-represent patients who are white and of higher socioeconomic status. At our diverse clinic we aspire to provide excellent care in a setting where all patients feel valued and understood. Our aim was to assess whether patients of different identities had similar experiences of health care delivery within our clinic. Findings aided in understanding the patient experience, identifying disparities, and increasing patient voice and representation.


      A survey was created by our Division Quality Improvement team, then sent to research faculty, our Division Equity, Diversity and Inclusion Council and adolescents in our Peer Leader program for feedback and revision. The survey encompassed health care delivery and patient identity. Health delivery was assessed via six Likert-scale questions and an open-ended question for general experiences. The Likert-scale questions asked respondents to rate their trust in clinic providers, comfort being themselves, feeling heard in clinic, feeling their providers understand and ‘get’ them, being respected in clinic and whether their goals for the clinic visit were met. Patient identity and background was based on self-report of race/ethnicity, gender identity, sex at birth, sexual orientation, religion, primary language at home and insurance status. The surveys were handed out by providers and nursing staff and completed anonymously following the visit from a convenience sample of patients. Statistical analysis was undertaken to evaluate for difference of individual questions and composite score along identity lines. Results were shared at open Division-wide meeting for reflection.


      212 surveys were completed over four months. When looking at ‘index’ group (group expected to benefit from privilege) vs non-index group responses (all others) there were no statistically significant differences in ‘topbox’ score (i.e. 5 out of 5 on likert-scale) for individual questions or all questions summed together, although Language other than English at home vs English and Christian vs Other Religion were close with p-values of 0.06 when all questions were summed together. White respondents checked the topbox on 86% of questions while all other respondents checked the topbox on 84% of questions (p=0.49). Further stratification by individual racial identity did not demonstrate difference. Public insurance respondents checked the topbox 88% of the time while private insurance respondents checked the topbox 89% of the time (p=0.62.) Patients who identified as heterosexual checked the topbox for 81% of questions while all others checked the topbox for 87% of questions (p=0.07) suggesting a protective effect for patients who did not identify as heterosexual.


      There were no statistically significant differences in patient experience in our clinic along the criteria studied in our survey though some approached significance. However, limitations include possible bias in who elected to answer questions, lack of availability of survey in other languages, and distribution of survey by medical team. We plan to re-survey our patients after translating the survey and increasing access to the survey by making it available via QR code scan throughout the clinic.

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