468 - Redesigning Patient-Reported Outcomes Survey Approaches to Optimize Equitable Representation of Family Voices

Poster Number: 468
Publication Number: 468.265

Background: Marginalized people often have poorer health outcomes due to suboptimal healthcare experiences. Assessing disparities in patient-reported outcomes (PROs) is difficult, mostly due to underrepresentation of these marginalized groups in conventional healthcare surveys and survey methodologies. In 2020, we implemented equity-focused interventions to amplify the voices of patients and families from these groups by redesigning our PRO program, utilized by our hospital to collect survey outcomes data for quality improvement and research.

Objective: To examine the impact of our equity-focused PRO Program redesign interventions on the racial, ethnic, language, education, and gender identity diversity of program participants.

Design/Methods: We conducted a retrospective analysis of demographic data from PRO Program surveys collected from January 2016 through September 2023. For each survey, patients or caregivers completed a standardized demographic survey in addition to PRO survey items. Demographic data included items to describe patient and caregiver racial and ethnic identity, preferred language of care, caregiver education, and gender identity. We implemented 23 discrete equity-focused interventions over 37 months starting in October 2022 (Fig 1). To examine the impact of these interventions, we separated data into pre-redesign (January 2016 – September 2022) and post-redesign (October 2022 – September 2023) phases. We conducted chi-squared analysis on each demographic category comparing proportions of participants in the pre-redesign versus post-redesign phases.

Results: We analyzed 10,169 surveys (9,186 pre-redesign and 983 post-redesign). The proportions of participants from marginalized groups were significantly higher in the post-redesign phase across all demographic categories studied (Table 1 and Fig 2): patient race/ethnicity (46.7% pre-redesign vs 77.8% post-redesign, p< 0.001); caregiver race/ethnicity (36.8% pre vs 67.2% post, p< 0.001); language of care (6.2% pre vs 24.0% post, p< 0.001); caregiver education (56.9% pre vs 61.0% post, p< 0.001); patient gender (0.0% pre vs 2.2% post, p< 0.001).

Conclusion(s): Equity-focused interventions we implemented for our PRO Program significantly enhanced diverse representation of family voices. These redesign interventions can serve as a model for equitable redesign of other healthcare programs.