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Provider cultural competence and racial disparity in doctor-patient relationships
Saha S, Gatchell MS, O M, Bates JT, Gordon HS, Long JA, Washington DL, Gerrity MS. Provider cultural competence and racial disparity in doctor-patient relationships. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
Provider cultural competence (CC) is widely endorsed as a means to reduce racial disparities in healthcare quality, but few studies have empirically examined the impact of CC on patient care. We sought to determine which dimensions of provider CC are associated with better relationships and greater equity of care across racial/ethnic groups.
Primary care providers (PCPs) at 4 VA Medical Centers completed 6 previously developed, self-administered scales representing different CC dimensions: Perceived Cultural Aptitude, Perceived Cross-Cultural Efficacy, Awareness of Racial Disparities, Valuing Diverse Perspectives, Support for Accommodating Patient Diversity, and Patient-Centered Orientation. We surveyed white and African American patients from participating PCPs' panels, assessing global ratings of PCPs, communication quality, interpersonal style, and trust. We tested which CC dimensions were associated with higher minority patient ratings, adjusting for clinic site and patient age, and accounting for clustering of patients within providers. For CC dimensions positively associated with minority patient ratings, we tested interactions between provider CC and patient race, to determine whether CC dimensions were associated with reduced disparity in outcome measures.
Among 97 participating PCPs, most were white (49%) or Asian (27%), and female (68%). Among 1016 Veterans, most were African American (62%) or white (31%), and male (93%). The CC dimension most consistently associated with higher minority patient ratings was Valuing Diverse Perspectives (VDP). PCPs scoring above the median on VDP received significantly higher ratings from African American patients on communication quality (beta 0.15, 95% CI .002-0.3, scale range 0-6, mean 5.51) and interpersonal style (beta 0.11, 95% CI .02-0.2, scale range 0-5, mean 4.67). Higher VDP was not associated with white patients' ratings of providers. We found significant provider VDP-patient race interactions for all outcome measures; racial disparities were present among PCPs with lower VDP scores but not among those with higher scores.
Providers placing higher value on diverse patient perspectives deliver care that results in more racially equitable patient experience.
The VDP scale holds promise as a tool to guide the content and evaluate the effectiveness of CC training that will result in more equitable patient care.