患者对医疗服务提供者种族匹配度及慢性病护理质量的认知

Patient Perceptions of Provider Race Concordance and Quality of Chronic Illness Care.

作者信息

Grant Benjamin, Soroka Orysya, Baquero Elizabeth, Ringel Joanna Bryan, Cherrington Andrea, Cummings Doyle M, Halladay Jacqueline R, Rajan Arvind, Safford Monika M

机构信息

Weill Cornell Medical College, Weill Cornell Division of General Internal Medicine, New York, NY, USA.

The University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

J Gen Intern Med. 2025 Jan 22. doi: 10.1007/s11606-024-09025-w.

DOI:10.1007/s11606-024-09025-w

PMID:39843675

Abstract

BACKGROUND

Black people are more likely to have hypertension and report lower quality of care than White people. Patient-provider race concordance could improve perceived quality of care, potentially lessening disparities.

OBJECTIVE

Investigate the association between patient-provider race concordance and patient-perceived quality of chronic disease care, as measured by the Patient Assessment of Chronic Illness Care (PACIC) scale.

DESIGN

Cross-sectional analysis of baseline data from a randomized trial with Black patients with persistently uncontrolled hypertension.

SETTING

Participants received care at one of 69 rural primary care practices in Alabama and North Carolina.

PARTICIPANTS

Three hundred and ninety-one Black patients with persistently uncontrolled hypertension enrolled in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial.

MAIN MEASURE

PACIC overall scores and subscale scores (patient activation, delivery system, goal setting, problem solving, follow-up).

RESULTS

Of 1592 patients enrolled in the SEC trial, 391 participants self-reported race concordance data and completed the PACIC. Most participants were age < 60 (52.4%), 65.2% identified as women, and 50.1% were beneficiaries of either Medicare or Medicaid. Those with patient-provider race concordance reported higher overall PACIC scores (58.8% vs 46.1%, p < 0.05), with higher sub-scores of goal setting (60.9% vs 46.8%, p < 0.05) and problem-solving (62.7% vs 48.0%, p < 0.05) compared to those without race concordance. Poisson regression models of participants age ≥ 60 years demonstrated that those with race concordance were more likely to have higher overall PACIC scores (RR 1.53, 95% CI 1.17-2.0, p = 0.002), goal-setting subscale scores (RR 1.63, 95% CI 1.24-2.15, p = 0.0005), and problem-solving subscale scores (RR 1.66, 95% CI 1.29-2.14, p < 0.0001). Those < 60 years of age had no significant findings comparing those with and without race concordance.

CONCLUSIONS

Older Black patients perceived greater quality of care if their providers were also Black.

摘要

背景

黑人比白人更易患高血压，且报告的医疗服务质量较低。患者与医疗服务提供者种族匹配可能会提高患者对医疗服务质量的感知，从而有可能减少差异。

目的

通过慢性病护理患者评估（PACIC）量表，调查患者与医疗服务提供者种族匹配与患者对慢性病护理质量感知之间的关联。

设计

对一项针对持续性高血压未得到控制的黑人患者的随机试验的基线数据进行横断面分析。

地点

参与者在阿拉巴马州和北卡罗来纳州的69家农村初级医疗诊所之一接受治疗。

参与者

391名持续性高血压未得到控制的黑人患者参加了东南部改善血压控制协作（SEC）试验。

主要测量指标

PACIC总分及各子量表得分（患者激活、服务提供系统、目标设定、问题解决、随访）。

结果

在参加SEC试验的1592名患者中，391名参与者自行报告了种族匹配数据并完成了PACIC量表。大多数参与者年龄小于60岁（52.4%），65.2%为女性，50.1%是医疗保险或医疗补助的受益者。与种族不匹配的患者相比，患者与医疗服务提供者种族匹配的患者报告的PACIC总分更高（58.8%对46.1%，p<0.05），目标设定（60.9%对46.8%，p<0.05）和问题解决（62.7%对48.0%，p<0.05）子量表得分更高。对年龄≥60岁的参与者进行的泊松回归模型显示，种族匹配的参与者更有可能获得更高的PACIC总分（相对风险1.53，95%置信区间1.17 - 2.0，p = 0.002）、目标设定子量表得分（相对风险1.63，95%置信区间1.24 - 2.15，p = 0.0005）和问题解决子量表得分（相对风险1.66，95%置信区间1.29 - 2.14，p<0.0001）。年龄小于60岁的参与者中，种族匹配与不匹配的比较无显著结果。