National Clinician Scholars Program, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2022 Feb 1;5(2):e220715. doi: 10.1001/jamanetworkopen.2022.0715.
Little is known about how discrimination in health care relates to inequities in hospital-based care because of limitations in the ability to measure discrimination. Consumer reviews offer a novel source of data to capture experiences of discrimination in health care settings.
To examine how health care consumers perceive and report discrimination through public consumer reviews.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study assessed Yelp online reviews from January 1, 2011, to December 31, 2020, of 100 randomly selected acute care hospitals in the US. Word filtering was used to identify reviews potentially related to discrimination by using keywords abstracted from the Everyday Discrimination Scale, a commonly used questionnaire to measure discrimination. A codebook was developed through a modified grounded theory and qualitative content analysis approach to categorize recurrent themes of discrimination, which was then applied to the hospital reviews.
Reported experiences of discrimination within a health care setting.
Perceptions of how discrimination in health care is experienced and reported by consumers.
A total of 10 535 reviews were collected. Reviews were filtered by words commonly associated with discriminatory experiences, which identified 2986 reviews potentially related to discrimination. Using the codebook, the team manually identified 182 reviews that described at least 1 instance of discrimination. Acts of discrimination were categorized by actors of discrimination (individual vs institution), setting (clinical vs nonclinical), and directionality (whether consumers expressed discriminatory beliefs toward health care staff). A total of 53 reviews (29.1%) were coded as examples of institutional racism; 89 reviews (48.9%) mentioned acts of discrimination that occurred in clinical spaces as consumers were waiting for or actively receiving care; 25 reviews (13.7%) mentioned acts of discrimination that occurred in nonclinical spaces, such as lobbies; and 66 reviews (36.3%) documented discrimination by the consumer directed at the health care workforce. Acts of discrimination are described through 6 recurrent themes, including acts of commission, omission, unprofessionalism, disrespect, stereotyping, and dehumanizing.
In this qualitative study, consumer reviews were found to highlight recurrent patterns of discrimination within health care settings. Applying quality improvement tools, such as the Plan-Do-Study-Act cycle, to this source of data and this study's findings may help inform assessments and initiatives directed at reducing discrimination within the health care setting.
由于衡量歧视的能力有限，人们对医疗保健中的歧视与医院为基础的护理中的不平等之间的关系知之甚少。消费者评论提供了一种新颖的数据源，可以捕捉医疗保健环境中歧视的体验。
通过公开的消费者评论来研究医疗保健消费者如何感知和报告歧视。
设计、地点和参与者：这项定性研究评估了美国 100 家随机选择的急性护理医院 2011 年 1 月 1 日至 2020 年 12 月 31 日的 Yelp 在线评论。使用关键词过滤技术，通过从常用问卷“日常歧视量表”中提取的关键字来识别可能与歧视相关的评论，该问卷用于衡量歧视。通过修改的扎根理论和定性内容分析方法制定了一个代码本，对歧视的反复出现的主题进行分类，然后将其应用于医院评论。
在医疗保健环境中经历的歧视报告。
消费者对医疗保健中歧视的体验和报告的看法。
共收集了 10535 条评论。通过与歧视经历相关的常用词进行过滤，确定了 2986 条可能与歧视相关的评论。使用代码本，团队手动识别了 182 条至少描述了一次歧视的评论。歧视行为按歧视行为者（个人与机构）、行为场所（临床与非临床）和方向（消费者是否对医护人员表达歧视性信念）进行分类。共有 53 条评论（29.1%）被编码为制度种族主义的例子；89 条评论（48.9%）提到了在临床空间发生的歧视行为，即消费者在等待或正在接受护理时；25 条评论（13.7%）提到了在非临床空间发生的歧视行为，如大堂；66 条评论（36.3%）记录了消费者对医疗保健人员的歧视行为。歧视行为通过 6 个反复出现的主题来描述，包括作为、不作为、不专业、不尊重、刻板印象和非人性化。
在这项定性研究中，消费者评论发现了医疗保健环境中歧视的反复出现模式。将质量改进工具（如计划-执行-研究-行动循环）应用于这种数据来源和本研究的结果，可能有助于评估和开展减少医疗保健环境中歧视的举措。
