Patient–Provider Race Concordance and Primary Care Suicide Risk Screening in the Veterans Health Administration

Abstract

Objective

To evaluate the association between patient–provider race concordance and the likelihood of being screened for suicide risk in Veterans Health Administration (VA) primary care settings.

Study Setting and Design

In November 2020, the VA expanded its national suicide risk identification strategy to include an annual universal suicide screening requirement. This study examined VA primary care visits from 2021 to 2022, where provider race and ethnicity could be identified. We examined the association between patient–provider race concordance and the probability of being screened for suicide risk, adjusting for patient and visit characteristics. Importantly, we also adjusted for provider fixed effects, which allowed us to estimate the effect of race concordant vs. non-concordant patient interactions for the same provider. We additionally conducted analyses stratified by provider race and ethnicity.

Data Sources and Analytic Sample

Patient visit data were extracted from the VA Corporate Data Warehouse. The analytic sample comprised 219,673 primary care visits and 196,968 unique patients.

Principal Findings

Sixty-two percent of all patients due for a screening were screened. Black patients had the lowest unadjusted screening rate of 58%. In adjusted analyses, we found that Black patients were 1.2 percentage points less likely to be screened compared to White patients (95% CI: −0.016, −0.008). Patient–provider race concordance was associated with a 0.4 percentage points higher likelihood of suicide screening (95% CI: 0.0002, 0.008). This small effect size represents 880 suicide screens and 33% of the Black–White screening gap. In separate analyses stratified by provider race and ethnicity, White providers were less likely to screen racially minoritized patients, and Hispanic and Asian providers were less likely to screen Black patients compared to White patients.

Conclusions

Patient–provider race concordance was associated with increased suicide screens. Despite the small absolute increase in screening, health systems should consider the role of race concordance in patient–provider interactions when developing strategies to aid nationwide efforts to prevent suicides.