Authors: Elizabeth Howell; Jihad Abdelgadir, MD, MSc; Edmund Ong, PhD; Salma Abdalla, MD, MPH; John Hunting, MPH; Mohamed Diab, MD; C. Rory Goodwin; Padma Gulur, MD; Michael Haglund (Durham, NC)

Introduction: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is utilized nationally to query patient perception of their healthcare across a broad array of domains, such as quality of care, communication, and overall hospital experience. Previous studies have established a correlation between demographic factors – such as race, ethnicity, gender, and socioeconomic status – and patient perception of the adequacy of their pain control. In this study, we examined the link between HCAHPS pain-domain responses and patient demographic variables in order to further characterize this relationship. Methods: This study included 107,287 records for adult patients discharged from a tertiary university-affiliated hospital between October 2015 and June 2017. Patient responses to HCAHPS pain management questions were collected. Of all records reviewed, 13,026 included responses to at least one HCAHPS pain management question. Systematic statistical analysis was then performed in order to evaluate potential interactions between demographic variables and HCAHPS response rates and types. Results: “Hispanic” and “Black or African American” respondents were more likely to report successful pain control when compared to “Not Hispanic” and “Caucasian/White” patients, respectively (ORs 1.60, 1.22). Additionally, among female patients, “Black or African American” respondents were more likely to have reported positive Staff Helpfulness than “Caucasian/White” respondents (OR 1.38). Notably, “Hispanic” and “Black/African American” patients were each less likely to respond to the HCAHPS pain-domain questions (OR 2.03, 2.74) than other respondents. Conclusion: Several demographic variables, including race/ethnicity and gender, appear to affect both the rate and type of response to HCAHPS questions centered around adequacy of pain control. Based on the above results, Hispanic and Black/African American patients may underreport negative experiences. Further investigation into this complex relationship is warranted, as demographic biases in HCAHPS responses could potentially undermine the utility of this data to inform healthcare decision-making and practice.