Patient-Provider Concordance Reduces Missed Appointments in Texas Primary Care Safety-Net Clinics

Abstract

Objectives: Evidence suggests that effective provider-patient relationships result in enhanced quality of care and can close health equity gaps, although little is known about the impact of racial and ethnic provider-patient concordant relationships. This study examined how patient-provider concordance impacts the likelihood of missing an appointment in a primary care setting.

Methods: We obtained electronic medical records (EMR) data from a large family medicine Federally Qualified Healthcare Center (FQHC) clinic in Texas between March and November 2020. A mixed-effects multivariable logistic regression model, with patient ID as a random effect, was used to account for the nested data structure of repeated appointments within each patient. We report predicted probabilities and average marginal effects of concordant visits vs. non-concordant visits by race/ethnicity.

Results: The analytic sample included 76,658 appointments for 31,123 unique patients. Provider-patient concordance occurred in 51% of all appointments. Bivariate analyses revealed that 20% of appointments with patient-provider concordance were missed, compared to 21% in appointments without patient-provider concordance. In the adjusted models, patient-provider concordance was associated with 5% lower odds of missed appointments. Sex, insurance type, and provider experience were also significant factors. Average marginal effects by race/ethnicity showed lower predicted probabilities of missed appointments for concordant visits, compared to non-concordant visits.

Interpretation: The decreased likelihood of missed appointments among patients with similar racial/ethnic backgrounds as their providers supports the notion that representation in healthcare is important, as it can contribute to fewer no-shows, which can lead to improved clinic efficiency.

Keywords: Appointments; Concordance; Ethnic groups; Patient-provider; Primary care; Racial.