Racial and ethnic differences in a patient survey - Patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization

BACKGROUND. Few studies have investigated the influence of race and/or ethn icity on patients' ratings of quality of care. None have incorporated patie nts' values and beliefs regarding medical care in assessing these possible differences. OBJECTIVES. We explored whether patients' values, ratings, and reports rega rding physicians' primary care performance differed by race and/or ethnicit y. RESEARCH DESIGN. This was a cross-sectional, mailed patient survey. SUBJECTS. The study subjects were adult primary care patients in a large he alth maintenance population (7,747 whites, 836 blacks, 710 Latinos, and 1,0 07 Asians). MEASURES AND METHODS. Ratings of the following dimensions of primary care w ere measured: technical competence, communication, accessibility, preventio n and health promotion, and overall satisfaction. Patients' values regardin g these dimensions and their confidence in medical care were measured. Mult ivariate analyses yielded associations of race/ethnicity with satisfaction and with reports of prevention services received. RESULTS. For 7 of the 10 dimensions of primary care measured, Asians rated physician performance significantly less favorably than did whites, includi ng differences among Asian ethnic subgroups. Latinos rated physicians' acce ssibility less favorably than did whites. Blacks rated physicians' psychoso cial and lifestyle health promotion practices higher than did whiles. No di fferences were found in patient reports of prevention services received, ex cept pacific Islanders reported receiving significantly more prevention ser vices than whites. CONCLUSIONS. In a large HMO population, significant differences were found by race and ethnicity, and among Asian ethnic subgroups, in levels of patie nt satisfaction with primary care. These findings may represent actual diff erences in quality of care or variations in patient perceptions, patient ex pectations, and/or questionnaire response styles. More research is needed t o assess, in accurate and culturally appropriate ways, whether health plans are meeting the needs of all enrollees.