Eyring J B, Hemeyer Brandon M, Wilson Fernando A
University of Utah School of Medicine, Salt Lake City, UT.
Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT.
Med Care. 2025 Aug 1;63(8):579-587. doi: 10.1097/MLR.0000000000002165. Epub 2025 Apr 28.
Patient-provider racial/ethnic concordance may mitigate disparities, which is likely due in part to improved communication. The COVID-19 pandemic exacerbated disparities and raised questions on communication, warranting further exploration to inform equitable care.
This study aimed to investigate the influence of patient-provider racial/ethnic concordance on patient-reported shared decision-making and communication during the early stages of the pandemic.
Stepwise logit models were constructed of short-term non-modifiable factors (race/ethnicity, education, age, marital status), modifiable factors (health insurance, poverty status), and self-reported health status predicting communication outcomes-whether the provider included the patient in decision-making and communicated treatment options.
Adults from the 2020 US Medical Expenditure Panel Survey (N=9634), weighted consistent with complex sampling.
Shared decision-making and communication of treatment options by the primary care provider were assessed by patient surveys. Demographic characteristics included race/ethnicity, poverty status, age, marital status, education, and insurance status.
Concordance was associated with greater age and socioeconomic status, and being married, White, and in good health. Concordance was associated with patient-reported shared decision-making and communication of treatment options. The associations between demographic characteristics and communication outcomes differed significantly by concordance status, which further differed by race/ethnicity. For example, shared decision-making was predicted by education for discordant Hispanic patients and marital status for discordant White patients, but neither were predictive among concordant patients.
The findings suggest a potential association between concordance on shared decision-making and communication dynamics, emphasizing the need for additional research to clarify how similarities and differences may influence health care interactions.
患者与医疗服务提供者在种族/民族上的一致性可能会减少差异，这可能部分归因于沟通的改善。新冠疫情加剧了差异，并引发了关于沟通的问题，需要进一步探索以提供公平医疗的依据。
本研究旨在调查在疫情早期阶段，患者与医疗服务提供者在种族/民族上的一致性对患者报告的共同决策和沟通的影响。
构建逐步逻辑回归模型，纳入短期不可改变因素（种族/民族、教育程度、年龄、婚姻状况）、可改变因素（医疗保险、贫困状况）以及自我报告的健康状况，以预测沟通结果，即医疗服务提供者是否让患者参与决策并传达治疗方案。
来自2020年美国医疗支出小组调查的成年人（N = 9634），权重与复杂抽样一致。
通过患者调查评估初级医疗服务提供者的共同决策和治疗方案沟通情况。人口统计学特征包括种族/民族、贫困状况、年龄、婚姻状况、教育程度和保险状况。
一致性与年龄较大、社会经济地位较高以及已婚、白人且健康状况良好有关。一致性与患者报告的共同决策和治疗方案沟通有关。人口统计学特征与沟通结果之间的关联因一致性状况而有显著差异，而这种差异在不同种族/民族中也有所不同。例如，对于不一致的西班牙裔患者，共同决策由教育程度预测；对于不一致的白人患者，共同决策由婚姻状况预测，但在一致的患者中，这两者都没有预测作用。
研究结果表明，在共同决策上的一致性与沟通动态之间可能存在关联，强调需要进一步研究以阐明相似性和差异如何可能影响医疗保健互动。
