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.