title: Health care discrimination, processes of care, and diabetes patients' health status.
abstract: OBJECTIVE
  We examined whether diabetes patients report discrimination when seeking health care, whether problems with interpersonal processes of care (IPC) were associated with discrimination reports, and the linkage between discrimination and patients' health.
  
  
  METHODS
  810 diabetes patients were surveyed. Surveys were linked to hemoglobin A1c (A1C) and total cholesterol test results.
  
  
  RESULTS
  14% of participants reported experiencing discrimination in health care during the prior year, including discrimination due to their race (8%), education or income (9%), age (7%), and gender (10% of women). Patients with poorer than average ratings of their IPC had 2-8 times greater risk of reporting health care discrimination. Patients reporting health care discrimination had A1C levels that were higher than other patients (P = 0.002), more symptoms (P < 0.01), and poorer physical functioning (P = 0.007).
  
  
  CONCLUSIONS
  Diabetes patients' reports of health care discrimination are strongly linked to the quality of their interactions with providers as well as multiple health outcomes.
  
  
  CONCLUSIONS
  Physicians exert control over the clinical encounter and should endeavor to reduce patients' perceptions of discrimination during outpatient visits. Such efforts may result in more satisfied patients as well as improved health outcomes.
authors.affiliation: Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D003920:Diabetes Mellitus / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D011287:Prejudice; D017064:Process Assessment, Health Care; D012044:Regression Analysis; D014922:Wisconsin