Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Racial disparities in healthcare persist, with evidence suggesting that bias contributes to inequities in care and outcomes for Black patients. Racial concordance between patients and clinicians has been proposed as one strategy to improve patient satisfaction and health outcomes, but its impact in acute care settings such as the emergency department (ED) remains underexplored. The objective of this study was to assess how racial concordance between patient and clinician, together with patient perceptions of how race affected their care, influence patient satisfaction with care in the ED.

Methods: This secondary analysis used data from a previously published text message–based survey of patients discharged from two EDs between August and September 2021. Patients were categorized as not completely discordant if at least one clinician (physician, advanced practice clinician, or nurse) shared their self-identified race. The primary outcome was patient ratings of experience with ED care (scored 0 = poor to 5 = excellent). Multivariable ordinal logistic regression was used to assess associations between racial concordance, perceived impact of race on care, and experience ratings.

Results: Of 516 respondents, 195 (37.8%) were classified as not completely discordant with at least one emergency clinician. Not completely discordant patients reported significantly lower experience ratings (scored 0 to 5) compared to racially discordant patients (median, 4 [3-5] vs 5 [3-5]; P = .01). In multivariable ordinal logistic regression, racial concordance was not independently significant in patient experience.

Conclusion: Contrary to expectations, in our population, racial concordance was not significantly associated with satisfaction in ED care. In the adjusted analysis, perceived negative impact on care due to race was the strongest independent predictor of lower overall satisfaction. These findings suggest that how patients perceived the role of race in their care may be more influential than simply patient-clinician concordance in the acute care setting. Further research is needed to investigate these factors in more diverse patient-clinician population and other ED settings to help inform policies focused on advancing health equity.