The Predictors of Patient–Physician Race and Ethnic Concordance: A Medical Facility Fixed-Effects Approach

Authors

  • Ana H. Traylor,

    1. Goldman School of Public Policy, University of California, Berkeley, CA
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    • Address correspondence to Ana H. Traylor, Ph.D. candidate, M.P.P., Kaiser Permanente, Care Management Institute, Program Offices, 1 Kaiser Plaza, 16L, Oakland, CA 94612; e-mail: ana.h.traylor@kp.org. Ana H. Traylor, Ph.D. candidate, M.P.P., is with the Goldman School of Public Policy, University of California, Berkeley, CA. Julie A. Schmittdiel, Ph.D., and Connie S. Uratsu, B.A., are with the Kaiser Permanente, Division of Research, Northern California, Oakland, CA and the Los Angeles School of Medicine and Public Health, University of California, Berkeley, CA. Carol M. Mangione, M.D., M.S.P.H., is with the David Geffen School of Medicine at UCLA, GIM/HSR, Los Angeles, CA. Usha Subramanian, M.D., M.S., is with the National Institute for Fitness & Sport, 250 University Blvd., Indianapolis, IN and the Department of Medicine, Regenstrief Institute for Healthcare Inc., Division of General Internal Medicine and Geriatrics, Roudebush VAMC, Indianapolis, IN.

  • Julie A. Schmittdiel,

    1. Kaiser Permanente, Division of Research, Northern California, Oakland, CA and the Los Angeles School of Medicine and Public Health, University of California, Berkeley, CA
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  • Connie S. Uratsu,

    1. Kaiser Permanente, Division of Research, Northern California, Oakland, CA and the Los Angeles School of Medicine and Public Health, University of California, Berkeley, CA
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  • Carol M. Mangione,

    1. David Geffen School of Medicine at UCLA, GIM/HSR, Los Angeles, CA
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  • Usha Subramanian

    1. National Institute for Fitness & Sport, 250 University Blvd., Indianapolis, IN and the Department of Medicine, Regenstrief Institute for Healthcare Inc., Division of General Internal Medicine and Geriatrics, Roudebush VAMC, Indianapolis, IN
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Abstract

Objective. To examine the predictors of patient–physician race/ethnicity concordance among diabetes patients in an integrated delivery system.

Data Source. Kaiser Permanente's Northern California Diabetes Registry of 2005.

Study Design. Logistic regression predicted concordance for each racial/ethnic group. Availability of a concordant physician, whether a patient chose their physician, and patient language were main explanatory variables.

Data Collection/Extraction Methods. The study population consisted of 109,745 patients and 1,750 physicians.

Principal Findings. Patients who chose their physicians were more likely to have a same race/ethnicity physician with OR of 2.2 (95 percent CI 1.74–2.82) for African American patients, 1.71 (95 percent CI 1.44–2.04) for Hispanic patients, 1.11 (95 percent CI 1.04–1.18) for white patients, and 1.38 (95 percent CI 1.23, 1.55) for Asian patients. Availability of a same race/ethnicity physician was also a predictor of concordance for African American patients (OR 2.7; 95 percent CI 2.45–2.98) and marginally significant for Hispanic patients (OR 1.02; 95 percent CI 1.01–1.02), white patients (OR 1.02; 95 percent CI 1.00–1.04), and Asian patients (OR 1.05; 95 percent CI 1.03, 1.07). Limited English language was a strong predictor of concordance for Hispanic patients (OR 4.81; 95 percent CI 4.2–5.51) and Asian patients (OR 9.8; 95 percent CI 7.7, 12.6).

Conclusion. Patient language, preferences, and the racial composition of the physician workforce predict race/ethnicity concordance.

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