Clinicians rely on patient characteristics to construct a compelling and accurate picture, such as the age, sex, or symptoms of a 25-year-old woman with lower abdominal pain.

But derogatory expressions are also sometimes used to describe patients. Terms like “poor historian,” “noncompliant,” or “no-show” routinely appear in clinical medicine, reflecting and reinforcing negative stereotypes. Recent research found that stigmatizing language is surprisingly common, across a wide swath of clinical settings, including outpatient clinics, emergency rooms, and inpatient hospital stays. The question is, how common is stigmatizing language in home health care, one of the fastest-growing outpatient settings? And how does it affect patient care?

In the new study, senior fellow Kathryn Bowles of the University of Pennsylvania’s Leonard Davis Institute of Health Economics and colleagues used machine learning to detect patterns in “judgment language,” one metric of stigmatizing words, in the notes of urban home health care clinicians. Drawing from data collected by a private company, the authors analyzed clinicians’ perceptions of a patient’s reliability (e.g., the patient “states,” “claims,” “admits”).

As Bowles and colleagues note, it was the first study of its kind to examine “the extent of stigmatizing language in home health care,” a rapidly growing site of care for more than 5 million Americans annually. Findings appear in the Journal of Medical Internet Research (JMIR) Nursing.

In a cohort of 45,384 patients, researchers examined over 260,000 patient notes. Applying their algorithm, Bowles and colleagues found that 10% of all notes included judgment language. More specifically, this language was most common among Hispanic and Black patients, followed by white and then Asian patients. In fact, Black and Hispanic patients were 14% more likely to have judgment language present in their notes than white patients.

Read the full article about racism in home health care by Sam Schotland at Futurity.