Using a health equity lens to measure patient experiences of care in diverse healthcare settings

Abstract

People who are structurally disadvantaged and marginalized often report poor health care experiences due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient experiences of care measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different equity-oriented health care scales. The first was piloted in a primary health care setting, where patients have an ongoing relationship with providers over time. The second was piloted in an emergency department, where care is provided on an episodic basis. Item Response Theory was used to develop the scales and evaluate their psychometric properties. The primary health care scale, tested with a cohort of 567 patients, showed that providing more equity-oriented health care predicted improvements in important patient self-report health outcomes over time. The episodic scale, tested in an emergency department setting with 284 patients, showed evidence of concurrent validity, based on a high correlation with quality of care. Both scales are brief, easy-to-administer self-report measures that can support organizations to monitor quality of care using an equity lens. The availability of both scales enhances the possibility of measuring equity-oriented health care in diverse contexts. Both scales can shed light on experiences of care using an intersectional lens and equity-oriented lens, providing a nuanced understanding of quality of care.