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Geographic context of blackwhite disparities in Medicare CAHPS patient experience measureshttp

Objective: To examine whether blackwhite patient experience disparities vary by geography and withincounty contextual factors.

Data Sources: 321 300 Medicare beneficiaries responding to the 20152016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several withincounty contextual factors.

Study Design: Mixedeffects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiarylevel casemix adjustors.

Principal Findings: Blackwhite disparities in patient experiences were smaller in counties with higher average patient experiences. Blackwhite disparities in patient experiences were not associated with countylevel poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries’ level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation.

Conclusions: Efforts to reduce blackwhite disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, lowincome, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.


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