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

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.