Journal of General Internal Medicine

, Volume 25, Issue 4, pp 357–362 | Cite as

Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices

Original Article

Abstract

Objective

To examine racial disparities in health care service quality.

Design

Secondary data analyses of visits by primary care service users in the Community Tracking Study household sample.

Setting

Sixty communities across the United States.

Participants

A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.

Measurements

Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.

Results

Blacks but not other minorities were more likely to have an appointment lag of more than 1 week (13% white vs. 21% black, p < 0.001). Blacks, Hispanics, and other minorities were more likely to wait more than 30 min before being seen by the physician (16% white vs. 26% black, p < 0.001; vs. 27% Hispanic and 22% other minority, p < 0.001 and p = 0.02, respectively) and were less likely to report that they were very satisfied with their care (65% white vs. 60% black, p = 0.02; vs. 57% Hispanic and 48% other minority, p = 0.004 and p < 0.001, respectively). The differences in appointment lag and wait time remain large and statistically significant after the inclusion of multiple covariates, including geographic controls for CTS site. For all groups, satisfaction with care was affected by objective measures of service quality. Differences in objective measures of service quality explained much of the black-white difference in satisfaction, though not differences for other minority groups.

Conclusion

There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.

KEY WORDS

racial disparities service quality appointment lag waiting time satisfaction 

Notes

Acknowledgement

Research support was provided, in part, by the Commonwealth Fund.

Conflicts of Interest

None

Supplementary material

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Appendix Table 1 (DOC 49 kb)
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Appendix Table 5 (DOC 61 kb)
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Appendix Table 6 (DOC 49 kb)
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Appendix Table 7 (DOC 49 kb)

References

  1. 1.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington: National Academy Press; 2003.Google Scholar
  2. 2.
    Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260:1743–48.CrossRefPubMedGoogle Scholar
  3. 3.
    Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington: National Academy Press; 2001.Google Scholar
  4. 4.
    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27:759–769.CrossRefGoogle Scholar
  5. 5.
    Fung CH, Elliott MN, Hays RD, et al. Patients’ preferences for technical versus interpersonal quality when selecting a primary care physician. Health Serv Res. 2005;40:957–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Sherbourne CD, Hays RD, Ordway L, DiMatteo MR, Kravitz RL. Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. J Behav Med. 1992;15:447–68.CrossRefPubMedGoogle Scholar
  7. 7.
    Prentice JC, Pizer SD. Delayed access to health care and mortality. Health Serv Res. 2007;42:644–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Shi L, Stevens GD. Disparities in access to care and satisfaction among US children: the roles of race/ethnicity and poverty status. Public Health Rep. 2005;120:431–41.PubMedGoogle Scholar
  9. 9.
    Shi L. Experience of primary care by racial and ethnic groups in the United States. Med Care. 1999;37:1068–77.CrossRefPubMedGoogle Scholar
  10. 10.
    Taira DA, Safran DG, Seto TB, et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.PubMedGoogle Scholar
  11. 11.
    Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38:789–808.CrossRefPubMedGoogle Scholar
  12. 12.
    Barr DA. Race/ethnicity and patient satisfaction: using the appropriate method to test for perceived differences in care. J Gen Intern Med. 2004;19:937–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Mead N, Roland M. Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices. BMJ. 2009;339:b3450.CrossRefPubMedGoogle Scholar
  14. 14.
    Baicker K, Chandra A, Skinner JS. Geographic variation in health care and the problem of measuring racial disparities. Perspect Biol Med. 2005;48:S42–S53.PubMedGoogle Scholar
  15. 15.
    The response rates in chronological order were 65%, 63%, 61%, and 56.5%. More details are available at http://www.hschange.com/index.cgi?data=02. Accessed December 12, 2009.
  16. 16.
    Our study population numbered 41,537. The minimum number of observations in a regression was 30,953.Google Scholar
  17. 17.
    For site-specific estimates of the Household Survey, the variance estimates from STATA are identical to those generated by SUDAAN. More details are available at http://www.hschange.com/CONTENT/575/. Accessed December 12, 2009.
  18. 18.
    Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.CrossRefPubMedGoogle Scholar
  19. 19.
    McGuckin N, Srinivasan N. Journey to work trends in the United States and its major metropolitan areas: 1960–2000. Publication No. FHWA -EP-03-058. Washington, DC: US Department of Transportation, 2003. Available at: http://www.fhwa.dot.gov/ctpp/jtw/index.htm. Accessed December 12, 2009
  20. 20.
    Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.CrossRefPubMedGoogle Scholar
  21. 21.
    Reschovsky JD, O’Malley AS. Do primary care physicians treating minority patients report problems delivering high-quality care? [Web Exclusive]. Health Aff. 2008;27:w222–w231. Available at: http://content.healthaffairs.org/cgi/reprint/27/3/w222. Accessed December 12, 2009.CrossRefGoogle Scholar
  22. 22.
    Gordon P, Chin M. Achieving a new standard in primary care for low-income populations: case studies of redesign and change through a learning collaborative. The Commonwealth Fund, 2004. Available at: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2004/Aug/Achieving-a-New-Standard-in-Primary-Care-for-Low-Income-Populations--Case-Studies-of-Redesign-and-Ch.aspx. Accessed December 12, 2009.
  23. 23.
    Schall MW, Duffy T, Krishnamurthy A, et al. Improving patient access to the Veterans Health Administration’s primary care and specialty clinics. Jt Comm J Qual Saf. 2004;30:415–23.PubMedGoogle Scholar
  24. 24.
    Nguyen GC, LaVeist TA, Harris ML, Datta LW, Bayless TM, Brant SR. Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1233–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Morris AB, Li J, Kroenke K, Bruner-England TE, Young JM, Murray MD. Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy. 2006;26:483–92.CrossRefPubMedGoogle Scholar
  26. 26.
    Thom DH, Ribisl KM, Steward AL, Luke DA. Further validation and reliability test of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37:510–17.CrossRefPubMedGoogle Scholar
  27. 27.
    Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med. 2005;165:1749–55.CrossRefPubMedGoogle Scholar
  28. 28.
    Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med. 2004;19:1096–1103.CrossRefPubMedGoogle Scholar
  29. 29.
    O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38:777–85.CrossRefPubMedGoogle Scholar
  30. 30.
    Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118:358–65.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  1. 1.Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Health Policy and ManagementColumbia University Mailman School of Public HealthNew YorkUSA
  3. 3.Harvard Kennedy SchoolCambridgeUSA

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