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Using Standardized Encounters to Understand Disparities in Patient Experiences
Marc N Elliott, RAND Corporation 
Lenny Lopez, Massachusetts General Hospital and Harvard Medical School 
Mark J Schlesinger, Yale School of Public Health 
Angelo E Volandes, Massachusetts General Hospital and Harvard Medical School 
*Robin M Weinick, RAND Corporation 

Keywords: Racial/ethnic disparities, patient experiences

A growing body of research demonstrates that patients from different racial and ethnic groups report differing experiences with the health care system when using well-validated measurement tools. However, relatively little is known about the reasons behind such differences. This study investigated the extent to which identical physician-patient interactions are perceived differently by members of different groups and by inference the extent to which racial/ethnic differences in reports and ratings of patient experiences with health care represent true differences as opposed to differences in expectations or scale use. Using primary data collected from a nationally-representative online panel (n= 567), we administered (1) questions on general expectations of care, (2) a series of five (randomly ordered) written vignettes detailing specific doctor-patient interactions, and (3) a doctor-patient interaction video. Respondents evaluated each encounter using questions drawn from the CAHPS? Clinician/Group Survey; respondents were further probed about their video rating using techniques based on motivational interviewing. We found that reported expectations were very similar across racial/ethnic groups, and that ratings of encounters were higher for vignettes that were intended to represent better communication but also varied little by race/ethnicity. There were no significant racial/ethnic differences in patient reports of concrete, more specific CAHPS? “reports” items regarding the doctors’ behavior (e.g., the extent to which the doctor listened carefully to the patient). However, there was some evidence that more subjective global ratings about the doctors’ overall quality differed by respondents’ race/ethnicity, and that the respondents’ explanation for their ratings may differ systematically by race/ethnicity. A closer understanding of the nature and causes of existing racial/ethnic differences in patient experiences with care measures will allow health care decisionmakers to more productively identify and address racial/ethnic disparities within the health care system.