Meghani Salimah H, Brooks Jacqueline M, Gipson-Jones Trina, Waite Roberta, Whitfield-Harris Lisa, Deatrick Janet A
NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, USA.
Ethn Health. 2009 Feb;14(1):107-30. doi: 10.1080/13557850802227031.
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 1,756 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.
了解患者与医疗服务提供者种族匹配是否与少数族裔改善的健康结果相关。
利用MEDLINE、HealthSTAR和CINAHL数据库对已发表的研究文献（1980 - 2008年）进行全面综述。如果研究至少有一个研究问题考察患者与医疗服务提供者种族匹配对少数族裔患者健康结果的影响且涉及美国的少数族裔，则纳入该研究。数据库检索和数据分析由两位作者分别独立进行。综述限于表格和文本形式的数据分析。由于各研究方法和结果存在差异，无法进行荟萃分析。
27项研究符合纳入标准。这些研究综合起来基于56276名患者和仅1756名医疗服务提供者的数据。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/拉丁裔（13.3%）和亚裔/太平洋岛民（4.3%）构成了患者样本的大多数。针对非裔美国人的医疗服务提供者样本中位数仅为16，亚裔为10，西班牙裔为2。综述呈现出混合结果。在27项研究中，仅9项研究（33%）表明患者与医疗服务提供者种族匹配与少数族裔的积极健康结果相关，而8项研究（30%）发现种族匹配与所研究的结果无关联，10项研究（37%）呈现出混合结果。分析表明，有同一种族的医疗服务提供者并未改善少数族裔的“服务接受情况”。在医疗保健利用、患者与医疗服务提供者沟通、偏好、满意度或尊重感知等领域未出现明确的结果模式。
尚无确凿证据支持患者与医疗服务提供者种族匹配与少数族裔的积极健康结果相关。研究限于四个种族/族裔群体，且通常采用少数族裔的小样本。需要进一步研究以了解哪些健康结果可能对患者与医疗服务提供者之间的文化亲近度更敏感，以及哪些患者、医疗服务提供者和环境层面的变量可能调节或介导这些结果。
