Modest and UnevenPhysician Efforts to Reduce Racial/Ethnic Disparities
Feb. 10, 2010
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WASHINGTON, DCWhile many U. S. physicians identify
language or cultural barriers as obstacles to providing high-quality patient
care, physicians efforts to overcome communication barriers are modest and
uneven, according to a new national study released today by the Center for Studying
Health System Change (HSC).
Nearly half (48.6%) of all U.S. physicians in 2008 reported that difficulty
communicating with patients because of language or cultural barriers was at
least a minor problem affecting their ability to provide high-quality care,
though less than 5 percent viewed it as a major problem, according to the study
funded by the Robert Wood Johnson Foundation (RWJF).
Despite consensus in the medical community about steps physicians can take
to address racial and ethnic disparities, physician adoption of several recommended
practices to improve care for minority patients ranged from 7 percent reporting
they have the capability to track patients preferred language to 40 percent
reporting they have received training in minority health issues to slightly
more than half reporting their practices provide some interpreter services,
the study found.
"Although disparities certainly stem from factors beyond the physician-patient
encounter, the ability of physicians to communicate effectively with patients
from diverse backgrounds is important to providing high-quality care,"
said HSC Senior Researcher James Reschovsky, Ph.D., coauthor of the study with
HSC Health Research Analyst Ellyn R. Boukus, M.A.
Physicians were asked whether their practice provides interpreter services;
whether their practice provides patient-education materials in languages other
than English; whether they have received training in minority health issues;
whether they receive reports containing patient demographic information, such
as race or ethnicity; whether their practice has information technology (IT)
to identify patients preferred language; and whether they receive reports about
the quality of care delivered to minority patients.
Based on HSCs nationally representative 2008 Health Tracking Physician Survey,
the study findings are detailed in a new HSC Issue BriefModest and Uneven:
Physician Efforts to Reduce Racial and Ethnic Disparitiesavailable
here. Funded by RWJF, the survey includes responses from more than 4,700
physicians, and the response rate was 62 percent.
Other key findings include:
- While nearly 97 percent of physicians have at least some non-English
speaking patients, only slightly more than half of physicians (56%) were in
practices that provided interpreter services in 2008.
- Among physicians in practices treating patients with any of four prevalent
chronic conditions-asthma, diabetes, congestive heart failure and depression72
percent in 2008 reported their practice provides patienteducation materials
for at least one of the four conditions. Yet, only 40 percent of physicians
in these practices reported providing patient-education materials in languages
other than English for at least one of the conditions.
- Less than one in four physicians (23%) indicated they receive reports
on patient demographics, such as race or ethnicity. Likewise, 22 percent of
physicians indicated their practice has IT capable of reporting patients preferred
language, but only a third of these physicians (7%) routinely used this capability.
- Nearly nine out of 10 physicians lacked a formal means to assess the
quality of care provided to patients across racial and ethnic groups. Only 11.8
percent of physicians reported access to reports on the quality of care they
provide stratified by patient race or ethnicity.
- Physicians in practices with a greater share of minority patients were
more likely to adopt each of the measures to address disparities. For example,
almost twice as many physicians reported providing interpreter services in practices
with a majority of minority patients, relative to those in low-minority practices-less
than 10 percent minority patients (72.3% vs. 39.2%). Similarly, there were large
differences in provision of patient-education materials in foreign languages
(60% vs. 24%), routine use of IT to access patients preferred languages (10.5%
vs. 4.3%) and quality reporting by racial/ethnic group (16.8% vs. 8.2%).
- Physicians in solo and group practices were less likely to adopt measures
to address disparities than those in institutional practices, such as hospitals,
health maintenance organizations (HMOs) and medical schools. For example, nearly
90 percent of physicians in group- or staff-model HMOs reported providing interpreter
services, compared with 34 percent of physicians in solo or two-physician practices.
The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded in part by the
Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.