The Patient Experience Divide: How Income Relates to Care Quality in the Primary Care Setting.

Area of Science:

• Health Services Research
• Socioeconomic Determinants of Health
• Patient Experience Measurement

Background:

• Income is a significant determinant of health outcomes in the U.S., with patient experience potentially mediating this relationship.
• Existing research on income and healthcare experiences is limited by outdated data and methodological constraints.
• Understanding current disparities in patient experience across income levels is crucial for addressing health inequities.

Purpose of the Study:

• To investigate the relationship between patient income and primary care experiences using recent national data.
• To assess how income influences various dimensions of patient experience, including access, communication, and coordination of care.
• To identify potential links between income-related patient experiences and broader health disparities.

Main Methods:

• A mixed-methods approach analyzed data from a national sample of 5016 adults.
• Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group survey (CG-CAHPS) and its Narrative Item Set (NIS).
• Quantitative analysis of closed-ended survey responses (composite measures) and qualitative coding of open-ended narratives were performed to evaluate aspects like access, communication, and emotional rapport.

Main Results:

• Low-income participants reported significantly fewer positive mentions and more negative mentions across multiple care aspects (e.g., access, communication, coordination) compared to higher-income individuals.
• Quantitative composite measures from CG-CAHPS showed consistently lower scores (3-5 points) for low-income patients across all domains.
• These patterns persisted even after controlling for socioeconomic factors like education.

Conclusions:

• Low-income patients consistently report inferior experiences in primary care compared to their higher-income counterparts.
• These negative patient experiences may be a contributing factor to observed disparities in morbidity and mortality.
• Further research is essential to elucidate the underlying causes and develop targeted interventions to ensure equitable, high-quality care for all socioeconomic groups.