Jetty Anuradha, Jabbarpour Yalda, Pollack Jack, Huerto Ryan, Woo Stephanie, Petterson Stephen
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, USA.
Medstar Hlth Spring Valley Prac, 4910 Massachusetts Ave Nw Ste 115, Washington, DC, USA.
J Racial Ethn Health Disparities. 2022 Feb;9(1):68-81. doi: 10.1007/s40615-020-00930-4. Epub 2021 Jan 5.
Racial concordance between patients and clinician has been linked to improved satisfaction and patient outcomes.
(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.
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.
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).
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.
患者与临床医生之间的种族一致性与更高的满意度及更好的患者治疗效果相关。
（1）研究非西班牙裔白人、非西班牙裔黑人、亚裔和西班牙裔患者中临床医生与患者种族一致的可能性；（2）评估患者与临床医生种族一致对每个种族/族裔群体医疗保健使用和支出的影响。
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与临床医生种族一致与急诊室（ED）使用、住院情况和总医疗费用之间的关联，并控制患者的社会人口统计学因素、保险覆盖情况、健康状况和调查年份固定效应。
在分析样本中的50626名成年人中，32350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、受教育程度低和非私人保险与患者与临床医生种族一致的可能性增加有关。与临床医生种族不一致的白人及西班牙裔患者相比，临床医生种族一致的白人及西班牙裔患者的急诊室使用率较低（分别为15.6%对17.3%，p = 0.02；12.9%对16.2%，p = 0.01）。临床医生种族一致的黑人、亚裔和西班牙裔患者的总医疗支出低于临床医生种族不一致的患者（分别低14%、34%和20%，p均<0.001）。
这些结果进一步证明了种族一致性有助于建立更有效的治疗关系并改善医疗保健这一假设。这些结果强调了围绕文化谦逊开展医学教育的必要性以及医疗保健劳动力多元化的重要性。
