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. 2020 Aug 21;22(8):e17048.
doi: 10.2196/17048.

Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter

Yulin Hswen  1   2   3   4 , Jared B Hawkins  4   5 , Kara Sewalk  4 , Gaurav Tuli  4 , David R Williams  6   7 , K Viswanath  6   8 , S V Subramanian  6   7 , John S Brownstein  4   5
Affiliations

Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter

Yulin Hswen et al. J Med Internet Res. .

Abstract

Background: Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys.

Objective: This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016.

Methods: In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014.

Results: Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau's 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White.

Conclusions: The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

Keywords: digital epidemiology; health disparities; health inequities; patient experience; policy; race; racial disparities; social determinants of health; social media.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Correlation between the patient experience user counts per state and the corresponding population estimates by US census. PTE: patient experience.
Figure 2
Figure 2
Correlation between the patient experience user counts per state and the corresponding population estimates by the US census by racial and ethnic group from 2013 to 2016.
Figure 3
Figure 3
Average patient sentiment by racial and ethnic group from 2013 to 2016.
Figure 4
Figure 4
Overall average patient experience sentiment by racial and ethnic group for the years from 2013 to 2016.
See this image and copyright information in PMC

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