Does Patient-Provider Racial/Ethnic and Language Concordance Impact Patient-Reported Experience of Care?

Authors

Vani C. Nimbal, Palo Alto Medical Foundation Research InstituteFollow
Beinan Zhao, Palo Alto Medical Foundation Research Institute
Jia Pu, Palo Alto Medical Foundation Research Institute
Robert J. Romanelli, Palo Alto Medical Foundation Research Institute
Latha Palaniappan, Stanford University School of Medicine
Sukyung Chung, Palo Alto Medical Foundation Research InstituteFollow

Publication Date

8-15-2016

Keywords

race/ethnicity/language concordance, patient satisfaction

Abstract

Background/Aims: Patient-provider race/ethnicity or language (REL) concordance can influence quality of communication and thus patient experiences of care. We explored this relationship among the largest and fastest growing immigrant populations in the United States –– Asian Indian, Chinese and Latinos –– compared to non-Hispanic whites (NHW).

Methods: Patient survey data (2013-2014) from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Survey were linked to electronic health records of patients in a large mixed-payer ambulatory care setting in northern California. We used multivariate logistic regressions to evaluate the effect of patient-provider REL concordance on patient experience of “Provider explanation understandable” (Yes, definitely vs. Yes, somewhat or No) and “Overall assessment of provider” (9 or 10 vs. 0–8 on scale of 0 [worst possible] to 10 [best possible]) after controlling for other visit and provider characteristics influencing patient experience of care.

Results: Among 51,401 and 51,168 patients who provided answers to the two measures, respectively, 3% were Asian Indians, 7% Chinese, 8% Latinos and 82% NHW. Asian Indian and Chinese gave lower ratings for both outcomes compared to NHW, and patients with limited English proficiency gave lower ratings on “Provider explanation understandable” than English-proficient patients. Chinese providers were not rated differently from non-Chinese providers among both Chinese patients with and without limited English proficiency. Spanish-speaking Latinos gave lower ratings on “Overall assessment of provider” to non-Latino providers who speak Spanish (self-reported) (odds ratio: 0.17) compared to non-Latino providers who don’t speak Spanish. English-speaking Latinos gave higher ratings on the measure to Latino providers (odds ratio: 2.54) than non-Latino providers.

Conclusion: The impact of REL concordance on patient satisfaction is not uniform across racial/ethnic groups. Asians rate communication and overall assessment of providers lower than NHW in the same setting, and REL concordance did not improve their ratings. Latinos may prefer racial/ethnic concordant providers for better cultural sensitivity and a sense of shared beliefs and experiences, but Latinos with limited English proficiency may perceive a discrepancy between expectation and experience with language concordant-only providers. Greater diversity in demographics of health care professionals may not necessarily lead to improved patient experience unless truly culturally concordant care is provided.

Recommended Citation

Nimbal VC, Zhao B, Pu J, Romanelli RJ, Palaniappan L, Chung S. Does patient-provider racial/ethnic and language concordance impact patient-reported experience of care? J Patient Cent Res Rev. 2016;3:198.