Inequity of Care: Perceived Differences in Quality of Care in the Homeless Population at Grady Memorial Hospital Open Access

Vellozzi-Averhoff, Cristina (Fall 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/ws859f70x?locale=en
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Abstract

Background:

Homelessness in the United States has a long history of stigma and bias, stemming from the time of colonialism. Over the years, homelessness has come to be associated with laziness and lack of purpose--an underserving poor. Stigma and bias infiltrate the healthcare system to affect the quality of care patients receive, but little to no data has reported on the quality of care for the homeless patient population. This research looks at empirical data from a social justice lens to examine the ethical implications of the impact of stigma on care quality for the homeless population at Grady Memorial Hospital. 

Materials and Methods:

This study looks at both qualitative quality of care data through a survey to gather the perspective of the patient as well as quantitative quality of care measures found in the electronic medical record. Out of 112 total participants, 33 were identified as homeless and 79 were identified as non-homeless. Statistical analysis was conducted via SPSS software to examine statistical differences in both the qualitative and quantitative data sets. 

Results: 

Homeless participants overall rated their care unfavorably with a global score of 2.85, whereas the non-homeless cohort rated their care favorably with a global score of 3.26. Several specific questions reflected statistical significance, including questions on patient-provider communication and staff responsiveness. Many of the retrospective quantitative metrics were equivalent between the two cohorts. 

Discussion/Ethical Analysis:

Homeless participants overall rated their care less favorably than did the non-homeless cohort. In particular, the homeless participants perceived worse communication between themselves and their providers as well as decreased responsiveness by providers. The significant differences in the quantitative review demonstrate reflections of implicit bias on the part of the providers towards the homeless cohort. These demonstrated differences reflect social injustices which violate deontological ethics, the social justice dimensions of well-being, as well as the bioethical principles of autonomy and non-maleficence. Hospital systems can put measures in place to highlight implicit bias so that providers are aware and work to rectify this disparity.

Table of Contents

Chapter 1: Background……………………….……………………………..….…1

Chapter 2: Ethical Framework……………………………………………….…...16

Chapter 3: Research Design and Methods……………………………………..…26

Survey Development……………………………………………………..27

Study Site and Design…………………………………………………....33

Data Collection……………………………………….…………………..35

Outcome Measures……………………………………………………….36

Survey Outcomes……………………………………………………36

Medical Record Review Outcomes…………………………………37

Statistics…………………………………..……………………………..37

Chapter 4: Results…………………………………………………….……...….40

Survey Results…………….……………………………………………..45

General Process of Care Measures Results………………………………51

Chapter 5: Discussion……………………………………………………...…….54

Survey Results Discussion……………………………………………….58

PCQ-H Based Questions…………….…………………………….59

HCAHPS Questions………………….……………………………61

General Process of Care Measures……………………………………….66

Chapter 6: Ethical Analysis………………...………………………………....…74

References………….………………………………………………………….....91

Appendix 1……….……………………………………………………………..100

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