Patient-provider race-concordance: does it matter in improving minority patients' health outcomes?
Patient-provider race-concordance: does it matter in improving minority patients' health outcomes?
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DOI：
10.1080/13557850802227031
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发表时间：
2009-02
影响因子：
3.1
通讯作者：
Deatrick JA
中科院分区：
文献类型：
--
作者：
Meghani SH;Brooks JM;Gipson-Jones T;Waite R;Whitfield-Harris L;Deatrick JA
了解患者-提供者种族一致性是否与少数民族健康结局改善相关。使用MEDLINE、HealthSTAR和CINAHL数据库对已发表的研究文献（1980-2008）进行了全面综述。如果研究至少有一个研究问题，检查患者-提供者种族一致性对少数民族患者健康结果的影响，并且与美国少数民族有关，则纳入研究。数据库检索和数据分析均由两位作者独立进行。审查仅限于表格和文本格式的数据分析。由于研究方法和结果的差异，无法进行荟萃分析。27项研究符合纳入标准。这些研究基于56，276名患者和1756名供应商的数据。白人/高加索人（37.6%）和黑人/非裔美国人（31.5%），其次是西班牙裔/拉丁美洲人（13.3%）和亚洲人/太平洋岛民（4.3%）构成了患者样本的大部分。提供者的中位数样本只有16个非洲裔美国人，10个亚洲人和两个西班牙裔。审查结果好坏参半。在27项研究中，只有9项研究（33%）的患者-提供者种族一致性与少数民族的积极健康结果相关，而8项研究（30%）发现种族一致性与研究结果无关，10项研究（37%）呈现混合结果。分析表明，有一个相同种族的提供者并没有改善少数民族的“接受服务”。在医疗保健利用、医患沟通、偏好、满意度或尊重感方面没有明确的发现模式。没有确凿的证据支持患者-提供者种族一致性与少数民族的积极健康结果相关。研究仅限于四个种族/族裔群体，一般采用少数群体的小样本。需要进一步研究，以了解哪些健康结果可能对患者和提供者之间的文化接近度更敏感，以及哪些患者，提供者和设置水平变量可能会缓和或调解这些结果。
To understand if patient–provider race-concordance is associated with improved health outcomes for minorities. A comprehensive review of published research literature (1980–2008) using MEDLINE, HealthSTAR, and CINAHL databases were conducted. Studies were included if they had at least one research question examining the effect of patient–provider race-concordance on minority patients’ health outcomes and pertained to minorities in the USA. The database search and data analysis were each independently conducted by two authors. The review was limited to data analysis in tabular and text format. A meta-analysis was not possible due to the discrepancy in methods and outcomes across studies. Twenty-seven studies met the inclusion criteria. Combined, the studies were based on data from 56,276 patients and only 1756 providers. Whites/Caucasians (37.6%) and Blacks/African Americans (31.5%), followed by Hispanics/Latinos (13.3%), and Asians/Pacific Islanders (4.3%) comprised the majority of the patient sample. The median sample of providers was only 16 for African Americans, 10 for Asians and two for Hispanics. The review presented mixed results. Of the 27 studies, patient–provider race-concordance was associated with positive health outcomes for minorities in only nine studies (33%), while eight studies (30%) found no association of race-concordance with the outcomes studied and 10 (37%) presented mixed findings. Analysis suggested that having a provider of same race did not improve ‘receipt of services’ for minorities. No clear pattern of findings emerged in the domains of healthcare utilization, patient–provider communication, preference, satisfaction, or perception of respect. There is inconclusive evidence to support that patient–provider race-concordance is associated with positive health outcomes for minorities. Studies were limited to four racial/ethnic groups and generally employed small samples of minorities. Further research is needed to understand what health outcomes may be more sensitive to cultural proximity between patients and providers, and what patient, provider and setting-level variables may moderate or mediate these outcomes.
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