Shahed Md Abu Sufian, MPH, Jeba Zaman Khan, MPH, and Anthony Goudie, PhD
Introduction: Patient-provider communication is a fundamental component of healthcare quality. Evidence suggests that concordance between patient’s and provider’s race/ethnicity produces greater patient adherence, mutual understanding, and satisfaction with the healthcare provider. However, prior studies identified that racial/ethnic concordance is not a significant predictor of patient-provider communication, and recent studies have not utilized nationally representative data. Hence, this study evaluated whether racial/ethnic concordance between the patient and provider is associated with improved patient-provider communication quality in a U.S. adult population.
Methods: This study used a retrospective cross-sectional design of secondary data aggregated from 2015-2019 Medical Expenditure Panel Survey household components. This study included civilian non-institutionalized U.S. adults aged 18 years and above, but less than 65 years who visited a provider in the 12 months prior to the survey interview. The outcome measure is the quality of patient-provider communication, which is self-evaluated by patients on four measures based on healthcare provider interaction: how often their providers listened carefully; expressed respect; explained clearly; and spent sufficient time during appointments. Racial/ethnic concordance between the patient and provider is the primary predictor. Multivariable logistic regression models included patient characteristics within the predisposing, enabling, and need domains of the Andersen Behavioral Model. The statistical significance level considered in this study is α=0.05.
Results: Among the 8,607 patients (48,009,868 weighted) responding to patient-provider communication quality questions, 65.7% had racial/ethnic-concordant visits. Among those, 59% were aged 45-64 years, 57% were female, 60% were currently married, 42% had some college education, 8% had family income below 100% of the poverty threshold, 85% held private insurance, and 54% made 3 or more visits to a provider. The distribution of racial/ethnic-discordant visits for non-Hispanic Whites, Hispanics, non-Hispanic Blacks, non-Hispanic Asians, and non-Hispanic other races were 40%, 22%, 23%, 8%, and 7% respectively. The Chi-square test revealed that all the patient characteristics except for education status and use of health services had a significant association with racial/ethnic concordance. Multivariable logistic regression model results demonstrated that racial/ethnic-concordant visits are statistically associated with providers listening carefully [adjusted odds ratio (AOR)=1.37, confidence interval (CI)=1.04-1.81, p=.024], explaining clearly [AOR=1.42, CI=1.1-1.83, p=.008], and showing respect [AOR=1.35, CI=1.04-1.76, p=.025]. There was no significant association with providers spending enough time with the patient [AOR=1.15, CI=0.93-1.42, p=.2].
Conclusions: This study identified that racial/ethnic concordance between patients and healthcare providers is a significant predictor of patient-provider communication quality. However, further investigation is warranted to evaluate other aspects of healthcare quality delivery that may be impacted by racial/ethnic concordance or discordance between the patient and healthcare providers.
Policy implications: Providers must be culturally sensitive when seeing patients of different races and ethnicities. This interaction dynamic may require additional attention and training during medical school.
To run the code, you will need SAS installed on your machine. Follow the steps below:
- Clone the repository:
git clone https://github.com/yourusername/SS-Racial-Concordance-and-Patient-Provider-Communication.git - Navigate to the
ProgramScriptfolder and open the SAS code file. - Run the code in SAS after collecting the required datasets.
For any questions or comments, please contact Shahed Sufian at [email protected].