Physician-patient race-match reduces patient mortality

Hill, Andrew J.; Jones, Daniel B.; Woodworth, Lindsey

doi:10.1016/j.jhealeco.2023.102821

Cited by 10 publications

(4 citation statements)

References 34 publications

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“…The DCo shared an ethnic background with a large proportion of patients, which also increased her trustworthiness [ 24 , 25 ]. Her training as a nurse enabled her to discuss with physicians when she faced incomplete medical prescriptions.…”

Section: Resultsmentioning

confidence: 99%

Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study

Cailhol,

Bihan,

Bourovali-Zade

et al. 2024

JMIR Form Res

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Background Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination.

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Section: Resultsmentioning

confidence: 99%

Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study

Cailhol,

Bihan,

Bourovali-Zade

et al. 2024

JMIR Form Res

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“…One benefit of a diverse workforce is delivery of more culturally responsive care (Ding et al, 2023;, and research underscores the advantages of patient-provider dyads that share a similar cultural background (Salsberg et al, 2021). First, racial/ ethnic concordance portends decreased mortality (Alsan et al, 2021;Hill et al, 2023) and heightened patient satisfaction (Howard et al, 2001), and when there is concordance between educators and students, we find more Black students in gifted programs (Grissom et al, 2017) and reduction in chronic absenteeism (Holt & Gershenson, 2015). Thus, diversifying the workforce compels programs to use holistic admission strategies that dismantle gatekeeping into the professions and foster diversity in cohorts.…”

Section: Diversify the Workforcementioning

confidence: 99%

Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth

Fannin,

Williams,

Fuller

et al. 2024

Autism Research

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Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1–14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629–1638; Smith et al., 2020. Pediatrics, 145, S35–S46.). Black 8‐year‐olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29–49.) where services may not be autism‐specific or have Individual Education Plan goals only focused on “behavior problems” (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261–3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411–424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech‐Language Pathology, 31, 2159–2174.). Additionally, ADMM researchers report consistent disparities in the identification of co‐occurring intellectual disability where Black autistic children have significantly more co‐occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, “…improved…access to services among historically underserved groups,” (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1–14.). We will then recommend strategies to address the ongoing disparities.

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“…Who becomes a doctor also matters for patients. There is a growing evidence base (albeit largely from the United States) showing that non-White patients treated by a doctor of the same ethnicity as them experience better health outcomes, including more precise diagnoses, improved medication adherence, and ultimately a lower risk of dying from manageable illnesses (Alsan, Garrick and Graziani, 2019;Frakes and Gruber, 2022;Hill, Jones and Woodworth, 2023).…”

Section: Introductionmentioning

confidence: 99%

Ethnic diversity of NHS doctors

Stockton,

Warner

2024

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Medicine is a high-paid and high-status career. It is also a big profession -and expected to grow considerably over coming decades. Understanding differences in access to medical careers by ethnicity, and different career paths within medicine by ethnicity, is therefore an important and interesting part of understanding the labour market experiences of people from different ethnic backgrounds more generally. There is also a growing evidence base (albeit largely from the United States) showing that non-White patients treated by a doctor of the same ethnicity as them experience better health outcomes. For both these reasons, the ethnic diversity of doctors working in the NHS matters. In this report, we use the Electronic Staff Record (ESR), the monthly payroll of all staff directly employed by NHS organisations, to examine the ethnicity mix of doctors working for the NHS in England and highlight differences across types of roles, gender and country of medical training. Key findings1. The share of doctors in the NHS who are non-White is far above the share of non-White people in the working-age population. In 2021, 51% of junior doctors and 41% of consultants were non-White (excluding those with unknown ethnicity). This compares with 20% of the English working-age population. Much of this is driven by international recruitment, with the vast majority of internationally trained doctors being non-White.But even among UK-trained doctors, 37% of junior doctors and 24% of consultants were non-White.2. Among junior doctors, every ethnic minority group makes up a larger share of the workforce than in the wider English working-age population. By far the largest non-White group is Asian, making up 33% of junior doctors in 2021 (excluding those with unknown ethnicity). 8% of junior doctors in 2021 were Black, compared with 5% of the working-age population. However, among UK-trained junior doctors, only 3% were Black.3. Among consultants (the most senior doctors in the NHS), not all ethnic minority groups make up a larger share than in the wider working-age population. As with junior doctors, by far the largest non-White group is Asian, making up 32% of consultants in 2021 (excluding those with unknown ethnicity). Just 3% of consultants were Black, compared with 5% of

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Physician-patient race-match reduces patient mortality

Cited by 10 publications

References 34 publications

Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study

Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study

Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth

Ethnic diversity of NHS doctors

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