The Predictors of Patient–Physician Race and Ethnic Concordance: A Medical Facility Fixed‐Effects Approach

Abstract

Objective. To examine the predictors of patient-physician race/ethnicity concordance among diabetes patients in an integrated delivery system. Data Source. Kaiser Permanente's Northern California Diabetes Registry of 2005. Study Design. Logistic regression predicted concordance for each racial/ethnic group. Availability of a concordant physician, whether a patient chose their physician, and patient language were main explanatory variables. Data Collection/Extraction Methods. The study population consisted of 109,745 patients and 1,750 physicians. Principal Findings. Patients who chose their physicians were more likely to have a same race/ethnicity physician with OR of 2.2 (95 percent CI 1.74-2.82) for African American patients, 1.71 (95 percent CI 1.44-2.04) for Hispanic patients, 1.11 (95 percent CI 1.04-1.18) for white patients, and 1.38 (95 percent CI 1.23, 1.55) for Asian patients. Availability of a same race/ethnicity physician was also a predictor of concordance for African American patients (OR 2.7; 95 percent CI 2.45-2.98) and marginally significant for Hispanic patients (OR 1.02; 95 percent CI 1.01-1.02), white patients (OR 1.02; 95 percent CI 1.00-1.04), and Asian patients (OR 1.05; 95 percent CI 1.03, 1.07). Limited English language was a strong predictor of concordance for Hispanic patients (OR 4.81; 95 percent CI 4.2-5.51) and Asian patients (OR 9.8; 95 percent CI 7.7, 12.6). Conclusion. Patient language, preferences, and the racial composition of the physician workforce predict race/ethnicity concordance.

The influence of patient–clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis

“…Patients who belonged to a minority group in the US and had the ability to choose their primary care clinician were more likely to have a clinician from the same ethnocultural background. [39][40][41] Our results further suggest that ethnocultural and language concordance were associated with higher odds of relational and management continuity. However, Chinese and South Asian patients reported receiving lower quality of care than patients of European descent.…”

Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)

“…We were not able to account for patient preferences in choosing their provider, which may also influence how individuals perceive discrimination. Previous studies (including within this diabetes population) found that minority patients are more likely to choose a provider of the same race/ethnicity (54, 55), and that black patients who reported a preference for a concordant physician were more likely to rate their physician as excellent (56). Other research has suggested that patients who perceive discrimination in race-discordant relationships were more likely to prefer a provider of the same race (57).…”

Demographic Characteristics of Applicants to, and Students of, Ontario Physiotherapy Education Programs, 2004–2014: Trends in Gender, Geographical Location, Aboriginal Identity, and Immigrant Status

“…Research on patient-physician race and ethnic concordance has identified that patients who chose their physicians were more likely to have a same-race or same-ethnicity physician. 28 Given the choice, immigrants would choose a health care professional of the same ethnic or cultural background, for a variety of reasons, including but not limited to language. 28 Additional research has identified that practitioners with the same cultural background as their patients may provide the most appropriate health care.…”

“…28 Given the choice, immigrants would choose a health care professional of the same ethnic or cultural background, for a variety of reasons, including but not limited to language. 28 Additional research has identified that practitioners with the same cultural background as their patients may provide the most appropriate health care. 29,30 Although the U.S. literature may help inform our thinking about a culturally competent workforce, it is important to note that the United States has a substantially lower percentage of immigrants than Canada at 13%, 31 and literature from that country focuses on minority groups that are often American born, such as African Americans and Hispanics/ Latinos.…”