Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations
Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations
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少数民族患者-医生种族一致性与改善医疗保健使用和降低医疗保健支出相关
DOI：
10.1007/s40615-020-00930-4
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发表时间：
2021-01-05
影响因子：
3.9
通讯作者：
Petterson, Stephen
中科院分区：
文献类型：
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作者：
Jetty, Anuradha;Jabbarpour, Yalda;Petterson, Stephen
背景患者和临床医生之间的种族一致性与满意度和患者结局的改善有关。目的：（1）检查非西班牙裔白色、非西班牙裔黑人、亚裔和西班牙裔患者中临床医生-患者种族一致性的可能性;（2）评价患者-临床医生种族一致性对每个种族群体内医疗保健使用和支出的影响。方法我们分析了2010-2016年医疗支出面板调查（MEPS）的数据。我们使用双变量和多变量模型来评估患者-临床医生种族一致性与急诊科（艾德）使用、住院和总医疗费用之间的相关性，控制患者社会人口统计学因素、保险范围、健康状况和调查年固定效应。结果在分析样本中的50，626名成年人中，32，350人与他们的临床医生种族一致。在亚裔和西班牙裔患者中，低收入、教育程度低和非私人保险与患者-临床医生种族一致性的可能性增加相关。与没有不一致临床医生的白人和西班牙裔患者相比，具有一致临床医生的白人和西班牙裔患者的急诊使用率较低（分别为15.6% vs. 17.3%，p = 0.02和12.9% vs. 16.2%，p = 0.01）。黑人、亚裔和西班牙裔患者中，种族一致的临床医生的总医疗支出低于种族不一致的临床医生（分别为14%、34%和20%，p < 0.001）。结论这些结果增加了支持种族一致性有助于更有效的治疗关系和改善医疗保健的假设的证据。这些结果强调了围绕文化谦逊的医学教育的必要性和医疗保健劳动力多样化的重要性。
Background Racial concordance between patients and clinician has been linked to improved satisfaction and patient outcomes. Objectives (1) To examine the likelihood of clinician-patient racial concordance in non-Hispanic White, non-Hispanic Black, Asian, and Hispanic patients and (2) to evaluate the impact of patient-clinician race concordance on healthcare use and expenditures within each racial ethnic group. Methods We analyzed data from the 2010-2016 Medical Expenditure Panel Survey (MEPS). We used bivariate and multivariate models to assess the association between patient-clinician race concordance and emergency department (ED) use, hospitalizations, and total healthcare expenses, controlling for patient socio-demographic factors, insurance coverage, health status, and survey year fixed effects. Results Of the 50,626 adults in the analysis sample, 32,350 had racial concordance with their clinician. Among Asian and Hispanic patients, low income, less education, and non-private insurance were associated with an increased likelihood of patient-clinician racial concordance. Emergency department use was lower among Whites and Hispanics with concordant clinicians compared to those without a discordant clinician (15.6% vs. 17.3%, p = 0.02 and 12.9% vs. 16.2%, p = 0.01 respectively). Total healthcare expenditures were lower among Black, Asian, and Hispanic patients with race-concordant clinicians than those with discordant clinicians (14%, 34%, and 20%, p < 0.001 respectively). Conclusions These results add to the body of evidence supporting the hypothesis that racial concordance contributes to a more effective therapeutic relationship and improved healthcare. These results emphasize the need for medical education surrounding cultural humility and the importance of diversifying the healthcare workforce.