Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race

  1. Lisa A. Cooper, MD, MPH;
  2. Debra L. Roter, DrPH;
  3. Rachel L. Johnson, BA;
  4. Daniel E. Ford, MD, MPH;
  5. Donald M. Steinwachs, PhD; and
  6. Neil R. Powe, MD, MPH, MBA
  1. From Johns Hopkins University School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.

    Abstract

    Background: African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits.

    Objectives: To compare patient–physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making.

    Design: Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis.

    Setting: 16 urban primary care practices.

    Patients: 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white).

    Measurements: Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction.

    Results: Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits.

    Conclusions: Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.

    Article and Author Information

    • Presented in part at the 23rd Annual Meeting of the Society of General Internal Medicine, Boston, Massachusetts, 6 May 2000.

    • Disclaimer: The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.

    • Acknowledgments: The authors thank Eliseo Guallar, MD, DrPH, for advice on revision of the manuscript.

    • Grant Support: By research grants from the Commonwealth Fund, the Bayer Institute for Health Care Communication, and the Robert Wood Johnson Foundation. Dr. Cooper was a fellow in the Robert Wood Johnson Foundation Minority Medical Faculty Development Program during the time this work was conducted.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Lisa A. Cooper, MD, MPH, Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205-2223; e-mail, lisa.cooper{at}jhmi.edu.

    • Current Author Addresses: Dr. Cooper, Ms. Johnson, and Dr. Ford: Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205-2223.

    • Dr. Roter: Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 750, Baltimore, MD 21205-1999.

    • Dr. Steinwachs: Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 482, Baltimore, MD 21205-1999.

    • Dr. Powe: Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205-2223.

    • Author Contributions: Conception and design: L.A. Cooper, D.L. Roter, D.E. Ford, N.R. Powe.

    • Analysis and interpretation of the data: L.A. Cooper, D.L. Roter, R.L. Johnson, D.E. Ford, N.R. Powe.

    • Drafting of the article: L.A. Cooper, D.L. Roter, R.L. Johnson, N.R. Powe.

    • Critical revision of the article for important intellectual content: L.A. Cooper, D.L. Roter, R.L. Johnson, D.M. Steinwachs, N.R. Powe.

    • Final approval of the article: L.A. Cooper, D.E. Ford, N.R. Powe.

    • Statistical expertise: L.A. Cooper, N.R. Powe.

    • Obtaining of funding: L.A. Cooper.

    • Administrative, technical, or logistic support: L.A. Cooper, N.R. Powe.

    Summary for Patients

    • Summaries for Patients:Communication in Health Care Visits when Doctors and Patients Have the Same versus Different Ethnic Backgrounds Ann Intern Med December 2, 2003 139:I-34
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    1. Ann Intern Med December 2, 2003 vol. 139 no. 11 907-915
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