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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2005 Dec;82(4):560–574. doi: 10.1093/jurban/jti125

The parent-provider relationship: Does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?

Gregory D Stevens 1,✉, Ritesh Mistry 2, Barry Zuckerman 3, Neal Halfon 4
PMCID: PMC3456673  PMID: 16221918

Abstract

Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and familycentered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childbood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4–35 months (n=1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P<.0011). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P<.011), No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P<..05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.

Keywords: Children, Patient-provider relationship, Primary care, Racial/ethnic disparities

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References

  • 1.Stevens GD, Shi L. Racial and ethnic disparities in the primary care experiences of children: a review of the literature. Med Care Res Rev. 2003;60:3–30. doi: 10.1177/1077558702250229. [DOI] [PubMed] [Google Scholar]
  • 2.Weech-Maldonado R, Morales L, Spritzer K, Elliot M, Hays R. Racial and ethnic differences in parents’ assessments of pediatric care in Medicaid managed care. Health Serv Res. 2001;36:575–594. [PMC free article] [PubMed] [Google Scholar]
  • 3.Seid M, Stevens G, Varni J. Parents’ perceptions of pediatric primary care quality: effects of race/ethnicity, language, and access. Health Serv Res. 2003;38:1009–1031. doi: 10.1111/1475-6773.00160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Newacheck PW, Hung YY, Wright KK. Racial and ethnic disparities in access to care for children with special health care needs. Ambul Pediatr. 2002;2:247–254. doi: 10.1367/1539-4409(2002)002&#x0003c;0247:RAEDIA&#x0003e;2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 5.Newacheck PW, Hughes DC, Stoddard J. Children’s access to primary care: differences by race, income and insurance status. Pediatrics. 1996;97:26–32. [PubMed] [Google Scholar]
  • 6.Starfield B, Shi L. The medical home, access to care, and insurance: a review of evidence. Pediatrics. 2004;113(suppl 5):1493–1498. [PubMed] [Google Scholar]
  • 7.Christakis DA, Wright JA, Zimmerman FJ, Bassett AL, Connell FA. Continuity of care is associated with well-coordinated care. Ambul Pediatr. 2003;3:82–86. doi: 10.1367/1539-4409(2003)003&#x0003c;0082:COCIAW&#x0003e;2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 8.Christakis DA, Wright JA, Zimmerman FJ, Bassett AL, Connell FA. Continuity of care is associated with high-quality care by parental report. Pediatrics. 2002;109:e54–e54. doi: 10.1542/peds.109.4.e54. [DOI] [PubMed] [Google Scholar]
  • 9.Christakis DA. Does continuity of care matter? Yes: consistent contact with a physician improves outcomes. West J Med. 2001;175:4–4. doi: 10.1136/ewjm.175.1.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Gill J, Mainous Ar, Nsereko M. The effect of continuity of care on emergeny department use. Arch Fam Med. 2000;9:333–338. doi: 10.1001/archfami.9.4.333. [DOI] [PubMed] [Google Scholar]
  • 11.O’Malley AS, Forrest CB. Continuity of care and delivery of ambulatory services to children in community health clinics. J Community Health. 1996;21:159–173. doi: 10.1007/BF01557996. [DOI] [PubMed] [Google Scholar]
  • 12.Smedley B, Stith A, Nelson A, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002. [PubMed] [Google Scholar]
  • 13.Collins K, Hughes D, Doty M, Ives B, Edwards J, Tenney K. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. New York, NY: The Commonwealth Fund; 2002. pp. 523–523. [Google Scholar]
  • 14.King WD, Wong MD, Shapiro MF, Landon BE, Cunningham WE. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? J Gen Intern Med. 2004;19:1146–1153. doi: 10.1111/j.1525-1497.2004.30443.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Veist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy. 2003;24:312–323. [PubMed] [Google Scholar]
  • 16.Saha S, Komaromy M, Koepsell T, Bindman A. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004. doi: 10.1001/archinte.159.9.997. [DOI] [PubMed] [Google Scholar]
  • 17.Cooper-Patrick L, Gallo J, Gonzales J, et al. Race, gender, and partnership in the patientphysician relationship. JAMA. 1999;282:583–589. doi: 10.1001/jama.282.6.583. [DOI] [PubMed] [Google Scholar]
  • 18.Ferguson W, Candib L. Culture, language, and the doctor-patient relationship. Fam Med. 2002;34:353–361. [PubMed] [Google Scholar]
  • 19.Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42:360–372. doi: 10.2307/3090184. [DOI] [PubMed] [Google Scholar]
  • 20.Veist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43:296–306. doi: 10.2307/3090205. [DOI] [PubMed] [Google Scholar]
  • 21.Veist TA, Carroll T. Race of physician and satisfaction with care among African American patients. J Natl Med Assoc. 2002;94:937–943. [PMC free article] [PubMed] [Google Scholar]
  • 22.Veist TA, Diala C, Jarrett N. Social status and perceived discrimination: who experiences discrimination in the health care system, how and why? In: Hogue C, Hargraves MA, Collins K, editors. Minority Health in America: Findings and Policy Implications from the Commonwealth Fund Minority Health Survey. Baltimore, MD: Johns Hopkins University Press; 2000. pp. 47–78. [Google Scholar]
  • 23.Burgess DJ, Fu SS, Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19:1154–1159. doi: 10.1111/j.1525-1497.2004.30227.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ryn M, Fu S. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93:248–255. doi: 10.2105/ajph.93.2.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(suppl 1):140–151. doi: 10.1097/00005650-200201001-00015. [DOI] [PubMed] [Google Scholar]
  • 26.Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000;21:75–90. [PMC free article] [PubMed] [Google Scholar]
  • 27.Saha S, Taggart S, Komaromy M, Bindman A. Do patients choose physicians of their own race? Health Aff (Millwood). 2000;19:76–83. doi: 10.1377/hlthaff.19.4.76. [DOI] [PubMed] [Google Scholar]
  • 28.Gray B, Stoddard J. Patient-physician pairing: does racial and ethnic congruity influence selection of a regular physician? J Community Health. 1997;22:247–259. doi: 10.1023/A:1025148302636. [DOI] [PubMed] [Google Scholar]
  • 29.Stevens GD, Shi L, Cooper LA. Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children. Ann Fam Med. 2003;1:105–112. doi: 10.1370/afm.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Zuckerman B, Stevens GD, Inkelas M, Halfon N. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics. 2004;114:1522–1529. doi: 10.1542/peds.2004-0635. [DOI] [PubMed] [Google Scholar]
  • 31.Green B, Palfrey J, editors. Bright Future: Guidelines for Health Supervision of Infants, Children aand Adolescents. 2nd ed. Arlington, VA: National Center for Education in Maternal and Child Health; 2000. [Google Scholar]
  • 32.Guidelines for Health Supervision III (Updated 2002) Elk Grove Village, IL: American Academy of Pediatrics; 1997. [Google Scholar]
  • 33.Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998. [Google Scholar]
  • 34.McLearn KT, Strobino DM, Minkovitz CS, Marks E, Bishai D, Hou W. Narrowing the income gaps in preventive care for young children: families in healthy steps. J Urban Health. 2004;81:556–567. doi: 10.1093/jurban/jth140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Flores G, Olson L, Tomany-Korman SC. Racial and ethnic disparities in early childhood health and health care. Pediatrics. 2005;115:e183–e193. doi: 10.1542/peds.2004-1474. [DOI] [PubMed] [Google Scholar]
  • 36.Yu SM, Bellamy HA, Kogan MD, Dunbar JL, Schwalberg RH, Schuster MA. Factors that influence receipt of recommended preventive pediatric health and dental care. Pediatrics. 2002;110:e73–e73. doi: 10.1542/peds.110.6.e73. [DOI] [PubMed] [Google Scholar]
  • 37.Stevens GD, Shi L. Racial and ethnic disparities in the quality of primary care for children. J Fam Pract. 2002;51:573–573. [PubMed] [Google Scholar]
  • 38.Flores G, Bauchner H, Feinstein AR, Nguyen U. The impact of ethnicity, family income, and parental education on children’s health and use of health services. Am J Public Health. 1999;89:1066–1071. doi: 10.2105/ajph.89.7.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Mustin HD, Holt VL, Connell FA. Adequacy of well-child care and immunizations in US infants born in 1988. JAMA. 1994;272:1111–1115. doi: 10.1001/jama.272.14.1111. [DOI] [PubMed] [Google Scholar]
  • 40.Minkovitz C, Mathew MB, Strobino D. Have professional recommendations and consumer demand altered pediatric practice regarding child development? J Urban Health. 1998;75:739–750. doi: 10.1007/BF02344504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93:635–641. doi: 10.2105/ajph.93.4.635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.McLearn KT, Strobino DM, Hughart N, et al. Developmental services in primary care for low-income children: clinicians’ perceptions of the Healthy Steps for Young Children program. J Urban Health. 2004;81:206–221. doi: 10.1093/jurban/jth108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334:1305–1310. doi: 10.1056/NEJM199605163342006. [DOI] [PubMed] [Google Scholar]
  • 44.Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273:1515–1520. doi: 10.1001/jama.273.19.1515. [DOI] [PubMed] [Google Scholar]
  • 45.Halfon N, Olson L, Inkelas M, et al. Summary Statistics from the National Survey of Early Childhood Health, 2000: National Center for Health Statistics. Vital Health Stat. 2002;15:1–25. [Google Scholar]
  • 46.Blumberg S, Olson L, Osborn L, Srinathh K, Harrison H, Abt Associates Inc Design and Operation of the National Survey of Early Childhood Health, 2000: National Center for. Health Statistics. Vital Health Stat. 2002;1:1–16. [PubMed] [Google Scholar]
  • 47.Blumberg SJ, Halfon N, Olson LM. The National Survey of Early Childhood Health. Pediatrics. 2004;113(suppl 6):1899–1906. [PubMed] [Google Scholar]
  • 48.Bethell C, Peck C, Schor E. Assessing health system provision of well-child care: the Promoting Healthy Development Survey. Pediatrics. 2001;107:1084–1094. doi: 10.1542/peds.107.5.1084. [DOI] [PubMed] [Google Scholar]
  • 49.Stoddard J, Back M, Brotherton S. The respective racial and ethnic diversity of US pediatricians and American children. Pediatrics. 2001;105:27–31. doi: 10.1542/peds.105.1.27. [DOI] [PubMed] [Google Scholar]
  • 50.Periodic Survey of Fellows PS#59. Elk Grove, IL: American Academy of Pediatrics; 2004. [Google Scholar]
  • 51.Krupat E, Hsu J, Irish J, Schmittdel JA, Selby J. Matching patients and practitioners based on beliefs about care: results of a randomized controlled trial. Am J Manag Care. 2004;10:814–822. [PubMed] [Google Scholar]
  • 52.Hsu J, Schmittdiel J, Krupat E, et al. Patient choice. A randomized controlled trial of provider selection. J Gen Intern Med. 2003;18:319–325. doi: 10.1046/j.1525-1497.2003.20145.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003;93:1713–1719. doi: 10.2105/AJPH.93.10.1713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25–36. [PubMed] [Google Scholar]
  • 55.Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–828. doi: 10.1016/S0277-9536(99)00338-X. [DOI] [PubMed] [Google Scholar]
  • 56.Garcia JA, Paterniti DA, Romano PS, Kravitz RL. Patient preferences for physician c characteristics in University-based primary care clinics. Ethn Dis. 2003;13:259–267. [PubMed] [Google Scholar]
  • 57.Doescher M, Saver B, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–1163. doi: 10.1001/archfami.9.10.1156. [DOI] [PubMed] [Google Scholar]
  • 58.Kaplan J, Bennett T. Use of race and ethnicity in biomedical publication. JAMA. 2003;289:2709–2716. doi: 10.1001/jama.289.20.2709. [DOI] [PubMed] [Google Scholar]
  • 59.Williams DR. Race/ethnicity and socioeconomic status: measurement and methodological issues. Int J Health Serv. 1996;26:483–505. doi: 10.2190/U9QT-7B7Y-HQ15-JT14. [DOI] [PubMed] [Google Scholar]
  • 60.Schulman K, Rubenstein L, Chesley F, Eisenberg J. The roles of race and socioeconomic factors in health services research. Health Serv Res. 1995;30:179–195. [PMC free article] [PubMed] [Google Scholar]
  • 61.LaVeist T. Beyond dummy variables and sample selecton:: What health services researchers ought to know about race as a variable. Health Serv Res. 1994;29:1–16. [PMC free article] [PubMed] [Google Scholar]

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