The Striking Effects of Diversity in Health Care: Improving Patient Outcomes

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Study results showed that the men who met with black physicians asked to receive more preventive services than men who met with nonblack physicians.
Study results showed that the men who met with black physicians asked to receive more preventive services than men who met with nonblack physicians.

The idea first came about at a coffee shop in Oakland, California.

Owen Garrick, MD, MBA, and Marcella Alsan, MD, MPH, PhD, sat together brainstorming a way to study the effects of diversity in health care, particularly for African American men in the United States.

“The motivator was the knowledge that black men had one of the lowest life expectancies of any major subgroup in the population,” said Dr Garrick, President and CEO of Bridge Clinical Research, an organization specializing in recruiting diverse patients for clinical trials. “We wanted to do something that answered an important research question but also had practical implications.”

And so the Oakland Men's Health Disparities Project was born. Dr Garrick and Dr Alsan, associate professor of medicine at the Stanford School of Medicine, designed the Oakland Men's Health Disparities Project.

The project involved renting a clinic, filling it with outside physicians (“fourteen black and nonblack male doctors”) and recruiting more than 1300 black men.

Dr Garrick and Dr Alsan told the physicians that the study was created to examine ways to improve the reception of black men to preventive care. They did not mention the role of race in their research.

The process occurred in 2 stages. The first stage surveyed the participants about their preference for preventive services before meeting the physician. The second stage surveyed the participants again after speaking with the physician.

The results showed that the men who met with black physicians asked to receive more preventive services than men who met with nonblack physicians. For more invasive tests like blood samples, only the participants who met with a black physician agreed to take up more services than their original choices in stage 1.

“The differential increase in services with black doctors was so substantial,” said Dr Garrick. “As an example, there was a 70-plus percent difference in the black physicians' ability to increase cholesterol screening uptake compared to non-black physicians. We found this to be both experimentally significant and medically meaningful.”

One of the most surprising results involved the group of men who showed the most mistrust for the medical system and chose the fewest preventive services during the first stage. After they met with a black physician, however, they changed their minds. These men became the group most likely to have more services performed in stage 2. This is another example of the importance of trust and communication between physician and patient that could have significant effects in health care.

Dr Garrick has experienced firsthand the effects of this study in his own career as a physician.

“I am sure that I have similar experiences to other minority physicians, when you meet a minority patient, where they have a combination of a sense of pride, [a] feeling of trust, and this comfort because you were there to care for them,” Dr Garrick said.

“Our findings suggest black physicians could help reduce cardiovascular mortality by 16 deaths per 100,000 person-year — leading to a 19% reduction in the black-white male gap in cardiovascular mortality,” the researchers wrote in their National Bureau of Economic Research study.

The field study by Dr Garrick and Dr Alsan provides an inside look at the importance of diversity among physicians and creating a trusting environment for patients. It also showed that increasing diversity could save lives.

Reference

Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. NBER Working Papers 24787, National Bureau of Economic Research, Inc. 2018.

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