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Background: Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys., Objective: This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016., Methods: In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014., Results: Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau's 5-year survey from 2016 (r 2 =0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White., Conclusions: The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA., (©Yulin Hswen, Jared B Hawkins, Kara Sewalk, Gaurav Tuli, David R Williams, K Viswanath, S V Subramanian, John S Brownstein. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.08.2020.)

Limited research has evaluated these equitable policies because of the difficulty of capturing LGBTQ patient experience. Previous studies have shown that LGBTQ persons report increased rates of discrimination across a wide variety of healthcare settings which may prevent them from disclosing their LGBTQ status. The goal of this research was to use a social media big dataset to evaluate the impact of equitable policies on patient experiences for LGBTQ persons., Competing Interests: Declaration of competing interest This study was funded by the Robert Wood Johnson Foundation Grant 73495 (to YH, JBH). Additional support was received from the NIH/National Human Genome Research Institute Grant 5U54HG007963-04 (to JSB, JBH). YH reports receiving funding from the Canadian Institutes of Health Research. The funders played no role in the study design; collection, analysis, or interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication., (Copyright © 2020 Elsevier Inc. All rights reserved.)