Understanding of Care and Race, Ethnicity and Language

Many factors can affect how people receive and understand health care, such as their race, ethnicity, language, income, education, and location. In this assessment, we will examine how these factors influence the comprehension of discharge instructions among hospital patients.

Some people may face difficulties in getting good health care because of their language, race, or ethnicity (HCUP, 2016). For example, they may get less effective treatment, have less communication with their providers, or face more risks of getting sick or injured (AHRQ, 2018, Carratala, 2020). Other factors that affect people’s health are their income, education, and occupation (Anderson et al., 2004, Evans et al., 2016). These factors also influence how likely people are to get COVID-19 or other diseases (Rubin, 2016, Henning-Smith et al., 2020). To improve health care for everyone, organizations need to address the differing needs of a diverse population to ensure the well-being of all they serve (Adler & Cutler, 2016, Artiga, 2023).

This analysis showed that there are significant differences in how well people understood the instructions they received when they left the hospital, based on their race and where they live. These differences may have implications for their health outcomes and quality of life. Therefore, it is important for health care organizations to recognize and address the diverse needs of their patients and provide them with clear, effective, and culturally appropriate communication.

This data is also available as an Excel spreadsheet.

Understanding of Care and County Race Demographics 2023 (Excel) (913.61 KB)

Data Sources
Data Definitions

This data represents the most current publicly available information sources that are commonly used to study health care trends. The data is derived from the data sources listed below and combined to support the analysis.

Hospital Compare - Patient Surveys - HCAHPS (data released July, 2023)
County Health Ranking (data released 2023)

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviation of the state where the hospital is located.

County: The name of the county where the hospital is located. County names are listed as provided on the US Census Bureau's list of 2020 FIPS Codes for Counties and County Equivalent Entities.

County Population Size: The total number of individuals residing in the county. The data is derived from the Census Population Estimates from 2021.

Population Type: The population type is determined based on the population size of a specific county. The population types include metro, nonmetro cities, and nonmetro towns. These types are adapted from the rural-urban commuting area codes (RUCA) and core-based statistical areas (CBSA) definitions of rural and urban. The population types for counties are defined as follows:

Metro - A population of 50,000 or more
Nonmetro cities - A population between 2,500 and less than 50,000
Nonmetro towns - A population of less than 2,500

Hospital: The name of the hospital.

Address: The address for the hospital.

City: The city where the hospital is located.

ZIP Code: The zip code for the hospital.

Percent Strongly Agree Understood Care: The percentage of patients who reported on the HCAHPS survey that they "Strongly Agree" they understood their care when they left the hospital. This data is from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey about patient experience and satisfaction. The reporting period for this measure is October 1, 2021, through September 30, 2022.

Number of Completed Surveys: The number of completed HCAHPS surveys by patients for the specific hospital. The number must be greater than 25 to be reported.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the US Census Bureau Population Estimates from 2021.

Percent Black: The proportion of the county’s population that falls into the racial or ethnic category of Black from the US Census Bureau Population Estimates from 2021.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the US Census Bureau Population Estimates from 2021.

Percent Native Hawaiian or Other Pacific Islander: The proportion of the county’s population that falls into the racial or ethnic category of Native Hawaiian or Other Pacific Islander from the US Census Bureau Population Estimates from 2021.

Percent Native American: The proportion of the county’s population that falls into the racial or ethnic category of Native American from the US Census Bureau Population Estimates from 2021.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the US Census Bureau Population Estimates from 2021.

Percent Not Proficient in English: The proportion of the county’s population that is not proficient in English from the American Community Survey from 2017-2021.

Tutorial Video

This tutorial video looks at the Understanding of Care and Race, Ethnicity and Language dashboard. The video guides you through how to use Tableau data analysis to compare them to determine if there is a difference in the relationship between the percentage of the population that reported they strongly understood discharge instructions and the percentage for the race categories at the county level.