Measuring Equity in the Hospital Setting: An HCAHPS Application of the Health Equity Summary Score

Megan K. Beckett
Katrin Hambarsoomian
Steven C. Martino
Denis Agniel
Sarah Hudson Scholle
Jessica L. Maksut
Megan Mathews
Nate Orr
Marc N. Elliott
Peer-Reviewed Article
August 2022


This description and application of a valid and reliable measure of equity of inpatient hospital experiences can help hospitals collect better data to meaningfully promote high-quality equitable care.


In hospital quality improvement efforts, using overall quality scores based on data for all patients without stratifying results by factors related to race and ethnicity, language preference, and social risk can obscure inequities between patients. This article describes the methodology and an initial assessment of the Health Equity Summary Score (HESS), which uses survey data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to measure equity in patient experience in a hospital setting


While the HESS approach was developed in the Medicare Advantage context, the HCAHPS HESS measure was found to be a valid and reliable measure of equity in inpatient hospital experience. A preliminary analysis found that HESS scores do identify equity-specific quality of care. Notably, higher-scoring hospitals were more likely to be small, not-for-profit, and serve a less diverse patient population.


The HCAHPS HESS measure can be a valuable tool for health systems and policymakers seeking to promote more equitable patient experiences.

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