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The COVID-19 pandemic has affected virtually every aspect of healthcare, shedding new light on disparities that have long existed but were exacerbated by the public health crisis.

But a new study involving patients seen in the pandemic’s early days in New York City shows that if given care on par with their most advantaged counterparts, minorities and socially disadvantaged patients can fare equally well.

 evaluated overall imaging utilization and outcomes in COVID-19 patients within vulnerable groups, and compared how much healthcare they used as well as their outcomes with those seen in groups not considered vulnerable.

The researchers also sought to learn whether any particular patient group had worse outcomes from COVID-19 than other vulnerable populations. Groups evaluated in the study included the elderly (65 years of age or older), racial or ethnic minorities, and those with vulnerable socioeconomic status, as defined by being on Medicaid, not having health insurance, being in prison, or being homeless).

New York City, an initial epicenter of the pandemic in the United States, has since made strides in reducing rates of the disease. But since the first weeks of the pandemic, evidence of unequal resource distribution and the virus’ disproportionate effects on vulnerable populations has become evident. Overall, the patient pool for the study included 1121 adults who tested positive for COVID-19 between March 3 and April 4, 2021, at centers in the New York Presbyterian Hospital (NYP) health system.

Of the 1121 patients included, 897 were considered part of a vulnerable population. Of those patients, 465 (41%) were elderly, 380 (34%) were racial or ethnic minorities, and 479 (43%) were considered to be at a socioeconomic disadvantage. Methods of imaging considered for the study included X-ray, CT, MRI, ultrasound, echocardiography, nuclear imaging, and invasive angiography. Some form of imaging was done in 88% of the patients, with scans mostly done bedside. Chest radiographs were done in 87% of patients.

Another aspect of treatment in the study was the highest level of care received, which researchers defined as 3 groups: outpatient, inpatient, and intensive care unit (ICU) admissions.

Among the vulnerable population subgroups, the biggest disparity in care and outcomes was seen among the elderly. They had more imaging performed, more hospitalizations with longer stays, a higher rate of ICU admissions, required intubation more often, and had a four-fold greater risk of mortality compared to non-elderly patients.

Minorities had a similar imaging rate compared with non-minority patients but were admitted to the ICU less frequently and had a lower risk of mortality compared with non-minorities. Those at with a socioeconomic disadvantage had outcomes similar to with no disadvantage.

The study stresses the importance of care availability, especially for the older population that fared worse in the analysis. The findings in regard to ethnic minority and socioeconomically disadvantaged patients surprised researchers given the overall disparity in vulnerable versus non-vulnerable populations. But the difference in this case was driven by the outcomes in elderly patients rather than the other subgroups.

“Our findings reinforce that racial health and social inequities, such as disproportionately high rates of poverty, medical comorbidities, and incarceration rates, are intimately connected and responsible for the disproportionate death rates among minorities, and highlight the importance of equitable access to inpatient medical care,” they wrote.

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The researchers also sought to learn whether any particular patient group had worse outcomes from COVID-19 than other vulnerable populations.

When Given Equal Care, Minorities and Disadvantaged Fared the Same as Others During COVID-19

In an era when hospitals and health systems must pay more attention to reputation management, a new study shows that some may be overlooking an obvious source of high marks: their own internal patient surveys.

, found that one of the best-known cancer centers in the world fared better on its internally generated patient satisfaction scores than it did on physician-rating websites.

Thus, the authors concluded, it may be in a hospital or health system’s own interest to voluntary publish patient satisfaction scores, which include more data and are more scientifically valid.

Gauging patient satisfaction with internal scores offers health care facility staff the opportunity to identify areas of strength as well as those that can be improved upon. Website ratings, by contrast, are a public forum used by patients who are looking for a physician. While each can useful, the two different strengths and weaknesses that the researchers sought to examine.

The internal scores, generated using the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey, were collected by The University of Texas MD Anderson Cancer Center, located in Houston. Internal scores were linearly transformed into a star rating on a 5-point scale for the purpose of the study, and physicians were only included if they had 30 or more internal patient reviews.

Overall, 510 physicians were included in the analysis. Median numbers of reviews and scores from internal surveys and the 4 most commonly used physician website ratings—Google, HealthGrades, Vitals, and WebMD—were compared for the study.

Researchers developed a measure that for the internal scores that examined the median score while looking more closely at the scores in the middle. The median was 4.89. For the physician website rating, the number of reviews per doctor ranged from 2 to 7, with median scores ranged from 4.4 to 5.

The research team noted a key weakness with online physician reviews: often there are not enough of them to make an assessment that is statistically meaningful, much less fair. This finding is consistent with a 

 by the firm Reputation, which found that 65% of physicians had no online reviews and 50% of health systems lacked them in 2020, a year when more people were seeking online information about healthcare than ever.

The researchers noted that in online reviews, a physician may be graded harshly for things that have nothing to do with the doctor-patient relationship, such as inadequate parking or a cranky receptionist. By contrast, the 8 validated questions from the CG-CAHPS used for internal surveys focus on the patient-provider relationship.

Other limitations included that fact that patient anonymity made it impossible to compare internal scores with online reviews written by the same people or to analyze demographics. Patients may also respond differently to surveys given by an institution than they would to an external review done online.

The study was originally done to convince MD Anderson’s providers that publishing survey results online would help their reputations. Doing so also highlighted the importance of giving providers a chance to improve over time without being haunted by old reviews. Under the cancer center’s system, old reviews to roll off after 12 months. Physician websites, on the other hand, often leave old reviews up indefinitely, even if a provider has gained experience and overcome a habit with training.

“In this study, we demonstrate the need to publish internal scores online to give patients more complete information regarding physician performance,” the authors concluded.

A study found that one of the best-known cancer centers in the world fared better on its internally generated patient satisfaction scores than it did on physician-rating websites.

Rose McNulty

Articles

When Given Equal Care, Minorities and Disadvantaged Fared the Same as Others During COVID-19

The Inside Scoop: A Cancer Center Fares Better on Patients’ Internal Ratings