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Abstract
Background Given the emphasis on promoting inclusive policies, we investigated the relationship between US hospitals’ inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse (LGBTQ+) populations and patient satisfaction from 2016 to 2023.
Methods This retrospective longitudinal observational study analysed 6 years of data between 2016 and 2023 from the Healthcare Equality Index (HEI), which measures hospitals’ LGBTQ+ inclusion efforts, and the Hospital Consumer Assessment of Healthcare Providers and Systems, which measures patient satisfaction. Generalised estimating equations (GEE) were used to obtain population-averaged estimates of the association between hospitals’ LGBTQ+ inclusion efforts—assessed by (1) their participation and (2) performance in the HEI (range: 0–100)—and patient satisfaction—measured by (1) patients’ hospital rating (range: 0–100) and (2) willingness to recommend the hospital (range: 0–100). We accounted for hospital characteristics, including medical teaching status, specialised service capability, hospital size, ownership, system membership, region and metropolitan location.
Results Compared with hospitals that never participated in the HEI, those that occasionally participated reported a 0.33-point higher patient rating (p=0.019, 95% CI 0.05, 0.60) and a 0.49-point higher patient recommendation score (p=0.011, 95% CI 0.11, 0.87). Those who always participated reported a 1.30-point higher rating (p<0.001, 95% CI 0.89, 1.70) and a 1.90-point higher recommendation score (p<0.001, 95% CI 1.36, 2.44). Among hospitals that participated in the HEI, a 10-point increase in the total HEI score was associated with a 0.10-point increase in patient ratings (p=0.031, 95% CI 0.01, 0.20) and a 0.15-point increase in patient recommendations (p=0.023, 95% CI 0.02, 0.28).
Conclusion Hospitals engaging in LGBTQ+ inclusion efforts are associated with higher patient satisfaction.
- accreditation
- organizational theory
- patient satisfaction
Data availability statement
Data may be obtained from a third party and are not publicly available. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data are available on the publicly accessible Hospital Compare website. Healthcare Equality Index data were obtained from the Human Rights Campaign Foundation, and American Hospital Association (AHA) data were sourced directly from the AHA. Requests for these data should be directed to the respective organisations.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data are available on the publicly accessible Hospital Compare website. Healthcare Equality Index data were obtained from the Human Rights Campaign Foundation, and American Hospital Association (AHA) data were sourced directly from the AHA. Requests for these data should be directed to the respective organisations.
Footnotes
X @hyunmin_yu
Contributors HY, MDM, JAB and HB made contributions to the conception and design of this article. HY, MDM, JAB and HB contributed to the acquisition, analysis and interpretation of data. HY drafted the manuscript. HY, MDM, JAB, TH and HB revised the manuscript. All authors approved the final manuscript. HY is the guarantor.
Funding The primary author (HY) received postdoctoral fellowship funding from the Eidos LGBTQ+ Health Initiative at the University of Pennsylvania.
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Competing interests TH holds a leadership position with the Human Rights Campaign. The remaining authors declare no conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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