Our team studies physician and health system factors associated with the quality, cost, and disparities in care. Our research efforts are currently prioritized in four major research areas.

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Patient-physician racial, ethnic, and gender concordance

We seek to investigate the effects of racial, ethnic, and gender concordance between patients and physicians on healthcare quality, cost, and disparities. Previous research has shown that concordance in race and ethnicity between patients and clinicians is associated with improved patient satisfaction, engagement and trust in care, and shared decision-making for patients from minority groups. However, whether such concordance translates to patient clinical benefits must be clarified. We propose to use innovative data with detailed clinical information on patient and physician characteristics to address this important knowledge gap. The findings from this research would highlight the importance of increasing the diversity of the physician workforce in the US and influence the content of medical education.

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Physician training environments

We propose to examine the effect of physician training environments (e.g., racial, ethnic, and gender diversity of medical school and residency programs; the existence of cultural competency programs in residency programs) on healthcare quality, cost, and disparities. We propose to conduct this research by linking three nationally representative databases: 1) Association of American Medical Colleges Student Roster Data, 2) American Medical Association Residency Program Data, 3) Medicare Claims Data, including Fee-for-service and Medicare Advantage. A better understanding of the impact of physician training environments would inform the redesign of medical education that improves healthcare quality, reduces costs, and improves health equity.

Doctor handing patient note

Physicians’ referral practices

We propose to examine how primary care physicians’ referral to specialists may differ based on race, ethnicity, and gender of patients (i.e., “referral bias”) and its implications on medical management and healthcare outcomes. Evidence suggests that primary care physicians’ decisions to refer their patients to specialists may differ based on patients’ race and gender rather than on clinical characteristics. However, whether this is a driver of differences in healthcare quality and outcomes by race, ethnicity, and gender has not been investigated. To address these critical knowledge gaps, our team proposes to use innovative social network analysis to examine whether patient referrals to specialists vary by the patient’s race, ethnicity, and gender and the impact of referral bias on the quality and outcomes of care received.

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International comparisons of health systems

We seek to gain insight into how the U.S. can improve health outcomes and mitigate rapidly growing health spending, by comparing the U.S. health system's performance with those of other high-income countries, with a particular emphasis on the accessibility and quality of care provided by primary care providers (PCPs). Although the U.S. health system spends nearly twice the Organisation for Economic Co-operation and Development (OECD) average on healthcare, the U.S. has a lower life expectancy and higher avoidable mortality than other high-income countries. While Americans utilize more expensive technologies such as magnetic resonance imaging (MRIs) and specialized procedures, they have fewer physician visits than individuals in comparable countries. Studies have shown that improving access to PCPs and improving the quality of care provided by PCPs have the potential to improve health outcomes and reduce healthcare spending within the U.S.