The Impact of Asian Patient Race/Ethnicity on Satisfaction Scores

Background
Patient satisfaction is increasingly being used to assess and financially reward provider performance. Previous studies suggest that patient race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for it.

Objective
To examine R/E differences in patient satisfaction ratings and how they impact provider rankings.

Design
A cross-sectional study of patient satisfaction data linked to electronic health records in two large outpatient centers in northern California – a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B).

Participants
Adult patients who received outpatient care at Site A (2010-2014) and Site B (2013-2014) and completed Press-Ganey Medical Practice Survey questionnaires (N=216,392 and N=30,690, respectively). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied.

Main Measures
For six questions each representing a survey subdomain, favorable ratings were defined as top-box (“very good”). Using multivariable logistic regression with provider random effects and adjusting for patient age and sex, we assessed whether the likelihood of giving favorable ratings differed by patient R/E.

Key Results
Asian, younger and female patients were less likely to give favorable ratings on patient satisfaction surveys than other R/E, older and male patients. The odds of top-box rating by Asian patients was significantly lower than that by NHW patients in both study sites (Site A: OR 0.56, 95% confidence interval: 0.54-0.57; Site B: OR 0.54, 95% CI: 0.49-0.59). The effect sizes for Asian R/E (OR 0.54-0.56) were greater than the effect sizes for older age (OR 1.43-1.52, OR 1.52-1.62) and female sex (OR 1.03-1.08). An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.

Conclusions
Scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.