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Miller AN, Duvuuri VNS, Vishanagra K, Damarla A, Hsiao D, Todd A, Toledo R. The Relationship of Race/Ethnicity Concordance to Physician-Patient Communication: A Mixed-Methods Systematic Review. HEALTH COMMUNICATION 2024; 39:1543-1557. [PMID: 37338139 DOI: 10.1080/10410236.2023.2223402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The concept of race or ethnic concordance between health care provider and patient has emerged as a dimension of the patient-physician relationship that could influence health outcomes for patients from minoritized groups, particularly through differences in the way physicians communicate with patients based on race or ethnicity. However, two decades of study on concordance and physician-patient communication have produced contradictory results. Given the heightened societal awareness of racism and the persistence of health disparities, there is a need for a comprehensive review of the current state of knowledge. This review sets out to determine how communication patterns differ in race/ethnicity concordant versus discordant patient-physician medical encounters. Thirty-three studies employing a range of methodologies were identified. In most analyses, after accounting for covariates, no relationship was found between race/ethnicity concordance and communication variables. Race/ethnicity concordance with their physician does not appear to influence the quality of communication for most patients from minoritized groups. A number of methodological weaknesses were identified in existing research, among them: few studies investigated potential explanatory variables, the heterogeneity of ethnic and cultural experience was over-simplified, there was little consistency in operationalization of communication variables, and the physician-patient dynamic was inadequately conceptualized.
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Affiliation(s)
- Ann Neville Miller
- Nicholson School of Communication and Media, University of Central Florida
| | | | - Kishan Vishanagra
- Burnett School of Biomedical Sciences, University of Central Florida
| | - Akhila Damarla
- Burnett School of Biomedical Sciences, University of Central Florida
| | - Diana Hsiao
- College of Medicine, University of Central Florida
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Persad-Paisley EM, Uriarte SA, Kuruvilla AS, Menville JE, Baranwal N, Francalancia SC, Lou MY, Zeyl VG, Rivera Perla KM, Rao V, Kalliainen LK. Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5552. [PMID: 38274104 PMCID: PMC10810573 DOI: 10.1097/gox.0000000000005552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024]
Abstract
Background There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians. Methods The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages. Results Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages. Conclusions Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.
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Affiliation(s)
| | - Sarah A. Uriarte
- From The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Annet S. Kuruvilla
- From The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Jesse E. Menville
- From The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Navya Baranwal
- From The Warren Alpert Medical School of Brown University, Providence, R.I
| | | | - Mary Y. Lou
- From The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Victoria G. Zeyl
- Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, Minn
| | | | - Vinay Rao
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Loree K. Kalliainen
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
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Hamwi S, Lorthe E, Severo M, Barros H. Migrant and native women's perceptions of prenatal care communication quality: the role of host-country language proficiency. BMC Public Health 2023; 23:295. [PMID: 36759808 PMCID: PMC9909846 DOI: 10.1186/s12889-023-15154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Despite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women's perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women. METHODS We aimed to examine the effect of women's host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants' language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27. RESULTS A high percentage of women (29%) rated communication quality as "optimal". Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives. CONCLUSIONS Facilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes.
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Affiliation(s)
- Sousan Hamwi
- EPIUnit- Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal. .,Laboratório Para a Investigação Integrativa E Translacional Em Saúde Populacional (ITR), Porto, Portugal.
| | - Elsa Lorthe
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland ,Université Paris Cité, INSERM, INRA, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France
| | - Milton Severo
- grid.5808.50000 0001 1503 7226EPIUnit– Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório Para a Investigação Integrativa E Translacional Em Saúde Populacional (ITR), Porto, Portugal
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit– Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório Para a Investigação Integrativa E Translacional Em Saúde Populacional (ITR), Porto, Portugal ,grid.5808.50000 0001 1503 7226Departamento de Ciências da Saúde Pública E Forenses, e Educação Médica, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
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Otte SV. Improved Patient Experience and Outcomes: Is Patient–Provider Concordance the Key? J Patient Exp 2022; 9:23743735221103033. [PMID: 35664933 PMCID: PMC9158407 DOI: 10.1177/23743735221103033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health disparities remain ubiquitous in the United States despite initiatives by the federal government and other organizations. A long-term solution for health inequity is needed in order to help improve patient outcomes for all. The purpose of this review is to examine if racial, gender, or multifactorial concordance (eg, race, age, gender, education, language) between patient and provider leads to a better patient experience and improved health outcomes. A PubMed search for articles published between 2016 and 2021 resulted in 23 separate studies that met inclusion criteria. The results from these studies were inconclusive in determining an association between patient–provider concordance and patient outcomes. Further research is needed to evaluate the positive, neutral, and sometimes negative impact of patient–provider concordance. By diversifying healthcare professions and improving cultural competency and communication training programs, providers may be better prepared to care for diverse populations in both concordant and discordant patient relationships.
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Assari S, Zare H. Beyond access, proximity to care, and healthcare use: sustained racial disparities in perinatal outcomes due to marginalization-related diminished returns and racism. J Pediatr Nurs 2022; 63:e161-e163. [PMID: 34629226 DOI: 10.1016/j.pedn.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Shervin Assari
- Marginalization-Related Diminished Returns (MDRs) Research Center, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of Maryland Global Campus, Health Services Management, Adelphi, MD, USA.
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Hollingsworth JM, Yu X, Yan PL, Yoo H, Telem DA, Yankah EN, Zhu J, Waljee AK, Nallamothu BK. Provider Care Team Segregation and Operative Mortality Following Coronary Artery Bypass Grafting. Circ Cardiovasc Qual Outcomes 2021; 14:e007778. [PMID: 33926210 PMCID: PMC8137653 DOI: 10.1161/circoutcomes.120.007778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data. METHODS Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients. RESULTS The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85-0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%-6.1%] versus 5.8% [95% CI, 4.7%-7.0%], respectively; P=0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%-12.4%] versus 3.3% [95% CI, 2.0%-5.4%], respectively; P=0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (-2.5%; P=0.098). CONCLUSIONS Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
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Affiliation(s)
| | - Xianshi Yu
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI
- Department of Statistics, University of Michigan College of Literature, Science, and Arts, Ann Arbor, MI
| | - Phyllis L. Yan
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Hyesun Yoo
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI
- Department of Statistics, University of Michigan College of Literature, Science, and Arts, Ann Arbor, MI
| | - Dana A. Telem
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | | | - Ji Zhu
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI
- Department of Statistics, University of Michigan College of Literature, Science, and Arts, Ann Arbor, MI
| | - Akbar K. Waljee
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Brahmajee K. Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI
- Division of Cardiology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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