The Impact of Community Characteristics on Patient Experience

By: Richard Goo and Dr. Nicole Kirchhoffer, RN
Maimonides Medical Center 

When individuals visit a hospital, either for their own or their loved one’s care, their expectations are based on the composite experience of their lifestyles, cultures, and background. Whether their goal is for their health to be fully restored or to maintain their quality of life, these experiences influence their healthcare continuum throughout their lifespan.

Patient experience (PX) has become a critical component of high-quality healthcare. As healthcare organizations seek to improve clinical quality and safety alongside experience, social determinants of health (SDOH) also need to be addressed. SDOH are non-medical aspects of one’s life such as educational level, income, and the diversity of the community in which they reside. By addressing SDOH, organizations can improve health outcomes and healthcare experiences by minimizing inequities and disparities that stem from SDOH.

Prior research has suggested rural communities reporting better patient experience survey results than their urban counterparts. Building on these prior studies, we analyzed inpatient satisfaction data (HCAHPS) from the Centers for Medicare & Medicaid Services against demographic data from the U.S. Census Bureau to understand potential relationships between SDOHs and patients’ likelihoods to recommend a healthcare facility. In particular, metropolitan and nonmetropolitan communities across New York State, a state known for its diversity, were compared to better understand potential gaps in healthcare disparities.

One finding was the relationship between education level and patient satisfaction. Patient communities with higher levels of education demonstrated a stronger, positive correlation with their likelihood to recommend a facility, particularly in nonmetropolitan areas. This suggests that education may influence a patient’s experience with their provider, how they navigate healthcare systems, or interpret their care experiences. Interestingly, this relationship was less pronounced in metropolitan settings, implying the complexity of urban healthcare environments.

Community diversity also presented a potential relationship with PX. Healthcare facilities located in moderately to highly diverse communities tended to report lower PX, with this effect more evident in metropolitan areas. Pairing diversity with poverty levels, patients were more likely to recommend facilities in communities with both low diversity and low poverty. Communities of higher diversity, regardless of poverty level, did not show a clear association with PX, indicating the possibility of more nuanced factors such as language barriers, cultural alignment, access challenges, or health literacy.

These findings highlight the importance of understanding local community contexts when creating PX initiatives particularly in Essential Hospitals that serve a large portion of highly diverse urban populations. The ideal one-size-fits-all approach, unfortunately, can undermine the unique needs of many community patients. As a next step, it is recommended for patient experience leaders to conduct an internal analysis of their organization’s patient experience survey data to identify targeted strategies for improvement. By aligning and curating PX efforts with the realities of the communities they serve, healthcare organizations can move toward more equitable and meaningful improvements in care.

About the Authors

Richard Goo is a Patient Experience Data Analyst at Maimonides Medical Center with a background in life science and research from New York University. He works closely with the patient experience team to identify notable insights and areas of opportunity from survey data to assist with data-driven quality improvement and health equity.

Nicole Kirchhoffer is the Assistant Vice President and Patient Experience Officer at Maimonides Medical Center in Brooklyn, New York. A registered nurse and healthcare leader, she oversees strategies that improve patient and family experience, strengthens staff engagement, and advances compassionate, patient-centered care across the organization.