The association between Asian patient race/ethnicity and lower satisfaction scores

Liao, Lillian; Chung, Sukyung; Altamirano, Jonathan; Garcia, Luis; Fassiotto, Magali; Maldonado, Bonnie; Heidenreich, Paul A.; Palaniappan, Latha

doi:10.1186/s12913-020-05534-6

Cited by 23 publications

(14 citation statements)

References 55 publications

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“…Outpatient Satisfaction Scores for Asian vs Non-Hispanic White Physicians demonstrated that Asian patients were less likely than white patients to give the most favorable LTR scores even after adjusting for known confounders. 26 Our finding that lower LTR scores given by Asian patients explains the lower LTR scores of Asian physicians should be considered with past work demonstrating that Asian patients are more likely to select midpoints, rather than extremes, when completing Likert-type 36 and CAHPS 37 surveys, which may consequently diminish the likelihood that Asian patients will provide the most favorable ratings.…”

Section: Jama Network Open | Health Policymentioning

confidence: 68%

“…24,25 In a recent study, we demonstrated that Asian patients were significantly less likely to provide the highest scores on the Press Ganey survey when evaluating physicians, even after controlling for a patient's sex and age. 26 Because previous research has demonstrated that patients may be more likely to select physicians of the same race/ethnicity as themselves, 27 the purpose of the present investigation was not only to examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians (hereafter simply referred to as white physicians) but also to consider whether these lower scores are mediated by the proportion of Asian individuals composing physicians' patient panels.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians

et al. 2019

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Importance Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients. Objective To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians. Design, Setting, and Participants This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018. Exposures Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken. Main Outcomes and Measures The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey. Results Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity. Conclusions and Relevance This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.

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Section: Jama Network Open | Health Policymentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians

et al. 2019

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“…Since this study was limited by the participants recruited from a medical center in Taiwan, the generalization could be limited to the geographic area. Moreover, the Consumer Assessment of Healthcare Providers and Systems and the Press Ganey Medical Practice Survey revealed that Asian patients reported lower healthcare experience ratings than did Caucasian patients (Chung, Mujal, Liang, Palaniappan, & Frosch, 2018; Liao et al, 2020). Indeed, the cultural background of the participants concerning their illness and perception play an essential factor in the administration of health care.…”

Section: Discussionmentioning

confidence: 99%

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

Lin

Siao

Tung³

et al. 2021

J of Nursing Scholarship

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Purpose This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients’ perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). Design A cross‐sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. Methods The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance‐Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. Findings A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = ‐2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in‐hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. Conclusions The patients’ expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients’ symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients’ perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. Clinical Relevance The managers of NPP need to pay attention to increasing NPs’ reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP‐to‐patient ratio, applying for certification programs in prescribing training, and cultivating patient‐centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

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“…[7][8][9][10] However, physicians often remain skeptical of current approaches to measure patient satisfaction, as instruments have been found to be vulnerable to bias, do not capture the full complexity of clinical care, and can pressure physicians to provide medically questionable care to boost their patient satisfaction performance scores. [11][12][13][14][15][16][17][18] Less well understood is how providing physicians with feedback regarding their patient satisfaction performance might impact their well-being. Occupational burnout is common in physicians and has important repercussions for patient safety, quality of care, patient satisfaction, cost, and physician turnover.…”

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confidence: 99%

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being

Vilendrer¹,

Kling²,

Wang

et al. 2021

Mayo Clinic Proceedings

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Objective: To evaluate how variation in the way patient satisfaction feedback is delivered relates to physician well-being and perceptions of its impact on patient care, job satisfaction, and clinical decision making. Participants and Methods: A cross-sectional electronic survey was sent to faculty physicians from a large academic medical center in March 29, 2019. Physicians reported their exposure to feedback (timing, performance relative to peers, or channel) and related perceptions. The Professional Fulfillment Index captured burnout and professional fulfillment. Associations between feedback characteristics and well-being or perceived impact were tested using analysis of variance or logistic regression adjusted for covariates. Results: Of 1016 survey respondents, 569 (56.0%) reported receiving patient satisfaction feedback. Among those receiving feedback, 303 (53.2%) did not believe that this feedback improved patient care. Compared with physicians who never received feedback, those who received any type of feedback had higher professional fulfillment scores (mean, 6.6AE2.1 vs 6.3AE2.0; P¼.03) but also reported an unfavorable impact on clinical decision making (odds ratio [OR], 2.9; 95% CI, 1.8 to 4.7; P<.001). Physicians who received feedback that included one-on-one discussions (as opposed to feedback without this channel) held more positive perceptions of the feedback's impact on patient care (OR, 2.0; 95% CI, 1.3 to 3.0; P¼.003), whereas perceptions were less positive in physicians whose feedback included comparisons to named colleagues (OR, 0.5; 95% CI, 0.3 to 0.8; P¼.003). Conclusion: Providing patient satisfaction feedback to physicians was associated with mixed results, and physician perceptions of the impact of feedback depended on the characteristics of feedback delivery. Our findings suggest that feedback is viewed most constructively by physicians when delivered through one-on-one discussions and without comparison to peers.

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The association between Asian patient race/ethnicity and lower satisfaction scores

Cited by 23 publications

References 55 publications

Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians

Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients’ Perspective

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being

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