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Gotschall JW, Fitzsimmons R, Shin DB, Takeshita J. Race, Ethnicity, and Other Patient and Clinical Encounter Characteristics Associated with Patient Experiences of Access to Care. J Patient Exp 2024; 11:23743735241241178. [PMID: 38529206 PMCID: PMC10962025 DOI: 10.1177/23743735241241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014-2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80-0.87), Asian (OR 0.62; 95% CI 0.58-0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72-0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery.
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Affiliation(s)
- Jeromy W. Gotschall
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Lodin HM, Bersoux S, Pannala R, Mi L, Vegunta S. Primary Care Delivery Perceptions and Their Associations with Physician and Patient Gender. J Community Health 2023; 48:711-717. [PMID: 36976390 DOI: 10.1007/s10900-023-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION We aim to survey patients' opinions on perceived differences in patient care delivered by male and female physicians. METHODS Patients of primary care practices at Mayo Clinic, Arizona completed a survey sent through the electronic health record. The survey evaluated opinion regarding their primary care physician (PCP)'s overall healthcare provision capabilities and any perceived differences based on gender. RESULTS 4983 patients' responses were included in final analysis. Compared to male patients, most female patients preferred to have a female PCP (78.1% vs. 32.7%, p < 0.01). Having a preference for female physicians was correlated with higher overall opinion of female physicians. The majority of male patients did not hold a difference in opinion regarding male versus female physicians (p < 0.01). Male patients were half as likely to have a better opinion and nearly 2.5 times more likely to have a worse opinion of female physicians (p < 0.01) compared to female patients. Patients preferring female physicians were nearly 3 times more likely to have a better opinion of female physicians compared to patients with no preference (p < 0.01). CONCLUSION In a primary care setting, majority of female patients compared to male patients preferred female physicians as their PCP and had higher opinion of the care delivery of female physicians. These findings may influence how practices should assign primary care physicians to new patients and add underlying context to patient satisfaction ratings.
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Affiliation(s)
- Hannah M Lodin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Sophie Bersoux
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Lanyu Mi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ, USA
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Bhojak NP, Modi A, Patel JD, Patel M. Measuring patient satisfaction in emergency department: An empirical test using structural equation modeling. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2112440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nimesh P. Bhojak
- Department of Hospital Management, Hemchandracharya North Gujarat University, Patan, India
| | - Ashwin Modi
- Department of Commerce and Management, Hemchandracharya North Gujarat University, Patan, India
| | - Jayesh D. Patel
- Ganpat University - V. M. Patel Institute of Management, Mehsana, Gujarat, India
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Stephens AR, Presson AP, Chen D, Tyser AR, Kazmers NH. Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey. Medicine (Baltimore) 2021; 100:e25211. [PMID: 33761706 PMCID: PMC9281982 DOI: 10.1097/md.0000000000025211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.
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Affiliation(s)
- Andrew R. Stephens
- Department of Orthopaedics, University of Utah, 590 Wakara Way
- University of Utah, School of Medicine, 30N 1900E
| | - Angela P. Presson
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Danli Chen
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Andrew R. Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way
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Nuyen B, Altamirano J, Fassiotto M, Alyono J. Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery 2021; 169:1441-1445. [PMID: 33531133 DOI: 10.1016/j.surg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear. METHODS This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ2 tests and generalized estimating equation regression models were run to assess correlation. RESULTS In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making. CONCLUSION Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
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Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open 2020; 3:e2024583. [PMID: 33165609 PMCID: PMC7653497 DOI: 10.1001/jamanetworkopen.2020.24583] [Citation(s) in RCA: 340] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. OBJECTIVE To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. EXPOSURES Patient-physician racial/ethnic and gender concordance. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. RESULTS In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). CONCLUSIONS AND RELEVANCE In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shiyu Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alison W. Loren
- Hematology/Oncology Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Justine Shults
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Deirdre L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
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Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Lee MO, Altamirano J, Garcia LC, Gisondi MA, Wang NE, Lippert S, Maldonado Y, Gharahbaghian L, Ribeira R, Fassiotto M. Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. West J Emerg Med 2020; 21:117-124. [PMID: 33207156 PMCID: PMC7673899 DOI: 10.5811/westjem.2020.8.47277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the “topbox” score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). Methods We looked at PG surveys from January 2015–December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: “Likelihood of your recommending our ED to others”; and “Courtesy of the doctor.” We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. Results We analyzed a total of 3,038 surveys. For “Likelihood of your recommending our ED to others,” topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70–0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60–0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54–0.93) and vertical areas (OR 0.71; 95% CI 0.53–0.95) compared to fast track. For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06–1.14); less likely among Asian (OR 0.70; 95% CI, 0.58–0.84), Black (OR 0.66; 95% CI, 0.45–0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55–0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50–0.95) compared to fast track. Conclusion Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.
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Affiliation(s)
- Moon O Lee
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Jonathan Altamirano
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Luis C Garcia
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Michael A Gisondi
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - N Ewen Wang
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Suzanne Lippert
- Kaiser-Permanente East Bay, Department of Emergency Medicine, Oakland, California
| | - Yvonne Maldonado
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Laleh Gharahbaghian
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Ryan Ribeira
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Magali Fassiotto
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
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The effect of nonmodifiable physician demographics on Press Ganey patient satisfaction scores in ophthalmology. J AAPOS 2020; 24:299-301. [PMID: 32890735 DOI: 10.1016/j.jaapos.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
Press Ganey patient satisfaction scores are increasingly being used as a physician quality metric. In this retrospective review of over 25,000 patient surveys for 61 ophthalmologists, pediatric ophthalmologists and neuro-ophthalmologists received significantly lower patient satisfaction scores than their peers, suggesting that the problem for which a patient seeks care may affect whether he or she is satisfied with the care received. These findings should be taken into account when considering the validity of Press Ganey scores as an equitable, modifiable measure of physician performance, especially when considering factoring these scores into physician evaluation and reimbursement.
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Solnick RE, Peyton K, Kraft-Todd G, Safdar B. Effect of Physician Gender and Race on Simulated Patients' Ratings and Confidence in Their Physicians: A Randomized Trial. JAMA Netw Open 2020; 3:e1920511. [PMID: 32083686 PMCID: PMC7043197 DOI: 10.1001/jamanetworkopen.2019.20511] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. DESIGN, SETTING, AND PARTICIPANTS This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. INTERVENTIONS A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. MAIN OUTCOMES AND MEASURES A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests. RESULTS Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism. CONCLUSIONS AND RELEVANCE No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04190901.
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Affiliation(s)
- Rachel E. Solnick
- National Clinical Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Gordon Kraft-Todd
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts
| | - Basmah Safdar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Tracy LF, Jabbour N, Rubin BR, Sobin LB, Lawlor CM, Basa KC, Levi JR, Tracy JC. Satisfaction in Academic Otolaryngology: Do Physician Demographics Impact Press Ganey Survey Scores? Laryngoscope 2019; 130:1902-1906. [DOI: 10.1002/lary.28335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Lauren F. Tracy
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Nicolette Jabbour
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Batsheva R. Rubin
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
- Boston University School of Public Health Boston Massachusetts
| | - Lindsay B. Sobin
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
| | - Claire M. Lawlor
- Department of Otolaryngology–Head and Neck Surgery Children's National Health System, George Washington University Washington DC
| | - Krystyne C. Basa
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
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