BEHAVIORAL SKILLS OF CULTURALLY COMPETENT PROVIDERS AND PATIENT REPORTED OUTCOMES
Miquell Miller*1, Monica Liu2, Cindy Kin1, Sylvia Bereknyei Merrell2, Arden Morris1
1General Surgery, Stanford University, Stanford, CA; 2School of Medicine, Stanford University, Stanford, CA
INTRODUCTION:
The SSAT and many others have recognized the importance of workforce diversity and cultural competence of providers. Although cultural competence among primary care physicians is associated with improved outcomes among socially vulnerable patients, little is known of the relationship between cultural competence and patient reported outcomes in surgery. Improving cultural competence of surgical providers may be one strategy to reduce disparities in surgical outcomes as well. Our objective was to determine the association between cultural competency of colorectal cancer providers with patient reported outcomes.
METHODS:
Providers in a tertiary cancer center were recruited to participate in a validated online survey that measured cultural competency, with a specific emphasis on cultural competency behaviors (CCB). Provider positions included: surgeons, oncologists, gastroenterologists and advanced practice providers. CCB scores were matched with publicly available 10-item Press Ganey provider care scores from 2017-2018 for all providers; scores were dichotomized into low- and high-level categories. The associations between provider CCB levels and their patient care satisfaction scores were assessed using logistic regression analyses. All analyses were adjusted for social desirability scores, age, race, position of provider and corrected for within-provider clustering of patients.
RESULTS:
Overall, 36 of 69 providers (52% response rate) completed the online cultural competency survey. Press Ganey scores from 1,322 patients were available for 80% of participating providers. Patients were more likely to report higher satisfaction with overall provider care for high CCB level providers compared to low CCB level providers (adjusted OR = 1.52, 95% CI [1.09-2.10] p = 0.01). Specific scores significantly associated with high CCB providers were "concern providers showed for patient's questions and worries"? (adjusted OR = 1.60, 95% CI [1.09-2.34] p = 0.02) and "degree care providers talked with patients using words they understood"? (adjusted OR=1.36, 95% CI [1.02-1.80] p = 0.03). (Figure 1) The remaining provider care scores were not statistically significant, however there was a clear trend of higher scores for high CCB providers compared to low CCB providers.
CONCLUSION:
Providers with high levels of behavioral cultural competence skills were more likely to have higher Press Ganey provider care satisfaction scores among several domains, highlighting the importance of cultural competence on patient care. Cultural competency training and interventions focusing on providers behaviors can be used as a means to improve patient reported outcomes in the clinical setting.
Figure 1: The association between provider cultural competency behavior (CCB) levels and their patient care satisfaction scores on Press Ganey provider care survey. High CCB providers had an increased odds of provider care satisfaction in several domains.
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