Patient-Centered Care is Associated with Decreased Health Care Utilization

摘要

id="p1">Purpose: This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization. id="p-2">Methods: Five hundred nine new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were their use of medical services and related charges monitored over 1 year. id="p-3">Results: Controlling for patient sex, age, education, income, self-reported health status, and health risk behaviors (obesity, alcohol abuse, and smoking), a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care (P = .0209), less frequent hospitalizations (P = .0033), and fewer laboratory and diagnostic tests (P = .0027). Total medical charges for the 1-year study were also significantly reduced (P = .0002), as were charges for specialty care clinic visits (P = .0005), for all patients who had a greater average amount of patient-centered visits during that same time period. For female patients, the regression equation predicted 15.47% of the variation in total annual medical charges compared with male patients, for whom 31.18% of the variation was explained by the average percent of patient-centered care, controlling for sociodemographic variables, health status, and health risk behaviors. id="p-4">Conclusions: Patient-centered care was associated with decreased utilization of health care services and lower total annual charges. Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered. class="kwd-group KWD">

>class="kwd-search" href="/search?fulltext=Charges+and+Fees&sortspec=date&submit=Submit&andorexactfulltext=phrase">Charges and Fees

>class="kwd-search" href="/search?fulltext=Patient-Centered+Care&sortspec=date&submit=Submit&andorexactfulltext=phrase">Patient-Centered Care

>class="kwd-search" href="/search?fulltext=Utilization&sortspec=date&submit=Submit&andorexactfulltext=phrase">Utilization id="p-5">Over the years, an extensive body of literature has described and advocated for a patient-centered approach to medical care.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1–12 In its 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,”id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5 the Institute of Medicine presented an action plan for reinventing the health system to improve our nation’s health. One of the 6 key components in achieving quality health care was identified as “patient-centeredness.”id="xref-ref-5-2" class="xref-bibr" href="#ref-5">5 Though there is no uniform definition of patient-centered communication, several scales have been developed to measure it.id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 It would seem that patient-centered care is a multifaceted construct, and instruments designed to measure it have varying levels of reliability and relatively low concurrent validity. Nonetheless, these instruments generally measure the following communication behaviors: eliciting understanding and validating the patient’s perspective; understanding the patient within his or her psychosocial context; reaching a shared understanding with the patient of the problem and its treatment; and creating a partnership in which “activated” patients share in decision making, power, and responsibility.id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 id="p-6">Health care organizations are being challenged to provide quality medical care while managing costs. A patient-centered approach is increasingly being considered a paradigm for high-quality interpersonal care. There is still a lack of consistent research evidence linking patient-centered care to improved patient outcomes,id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8id="xref-ref-13-1" class="xref-bibr" href="#ref-13">,13–17 but it has been demonstrated that a practice style emphasizing patient activation is associated with significantly lower primary care charges.id="xref-ref-18-1" class="xref-bibr" href="#ref-18">18 Moreover, there is emerging evidence for an association between patient-centered communication and the utilization of medical resources. It has been found that patients who perceived their visit as having been patient-centered received fewer diagnostic tests and referr