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

Key Points

Question

Is patient-physician racial/ethnic or gender concordance associated with the patient experience as measured by scores on the Press Ganey Outpatient Medical Practice Survey?

Findings

In this cross-sectional analysis of 117 589 Press Ganey surveys completed for the adult outpatient practices of an urban, academic health system from 2014 to 2017, physicians among racially/ethnically discordant patient-physician dyads had significantly lower odds of receiving the maximum patient experience score compared with those among concordant dyads.

Meaning

In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians; thus, efforts to improve the patient experience among racially/ethnically discordant patient-physician dyads may be necessary to improve health care delivery.

Abstract

This cross-sectional study evaluates the associations between the patient experience as measured by scores on the Press Ganey Outpatient Medical Practice Survey and patient-physician racial/ethnic and gender concordance.

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.