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Cited by 698Patient Satisfaction in HealthcareDiversity and Career in MedicinePatient-Provider Communication in Healthcare

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Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings

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Takeshita, Junko, Wang, Shiyu, Loren, Alison W., Mitra, Nandita, Shults, Justine, Shin, Daniel B., Sawinski, Deirdre L.·2020·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.24583PMC PMC7653497
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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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Figure. Adjusted Odds Ratios (ORs) for Maximum Press Ganey Score by Patient-Physician Racial/Ethnic and Gender Discordant Pairs Patient-physician racial/ethnic and gender concordance regression models included the following variables: patient age, gender, race/ethnicity, education, income, marital status, insurance, primary language, overall health, and mental and emotional health; physician age, gender, race/ethnicity, academic track (gender concordance only), and academic rank; and clinical encounter type, location, and specialty. Scores refer to scores on the Press Ganey Outpatient Medical Practice survey. Patient-physician concordant pairs serve as the reference.
Figure. Adjusted Odds Ratios (ORs) for Maximum Press Ganey Score by Patient-Physician Racial/Ethnic and Gender Discordant Pairs Patient-physician racial/ethnic and gender concordance regression models included the following variables: patient age, gender, race/ethnicity, education, income, marital status, insurance, primary language, overall health, and mental and emotional health; physician age, gender, race/ethnicity, academic track (gender concordance only), and academic rank; and clinical encounter type, location, and specialty. Scores refer to scores on the Press Ganey Outpatient Medical Practice survey. Patient-physician concordant pairs serve as the reference.CC BY · PubMed Central

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Research works printed but not linked: 1

  1. Press Ganey. Guide to interpreting: part 2—statistics. Published 2014. Accessed August 10, 2020. https://helpandtraining.pressganey.com/lib-docs/default-source/ip-training-resources/guide-to-interpreting---part-2.pdf?sfvrsn=2

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Metadata

Authors
Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L.
Affiliations
  • University of Pennsylvania (US)
  • Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
Corresponding author
Takeshita, Junko
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2020-11-09
Volume
3
Issue
11
Pages
e2024583
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.24583
PMC
PMC7653497
OpenAlex
W3099608639
Cited by
697
References
41
Citations by year
2026: 81 · 2025: 152 · 2024: 159 · 2023: 140 · 2022: 111 · 2021: 51 · 2020: 1
FWCI
79.10
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • Pfizer
  • University of Pennsylvania
  • National Institutes of Health
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR068433)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
gender concordance, physician-patient relationship, patient experience, racial disparities, Black patients, Asian patients, physician gender, outpatient care, patient satisfaction, health care delivery improvement, Philadelphia
MeSH terms
Adult, Aged, Cross-Sectional Studies, Delivery of Health Care, Ethnicity, Female, Gender Identity, Humans, Male, Middle Aged, Pennsylvania, Physician-Patient Relations, Physicians, Quality of Health Care, Surveys and Questionnaires, Universities, Patient Satisfaction, Patient Outcome Assessment

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