Association of shared decision-making on patient-reported health outcomes and healthcare utilization
Association of shared decision-making on patient-reported health outcomes and healthcare utilization
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DOI：
10.1016/j.amjsurg.2018.01.011
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发表时间：
2018-07-01
影响因子：
3
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Hughes, Tasha M.;Merath, Katiuscha;Pawlik, Timothy M.
背景：共同决策（SDM）是一个尊重患者充分参与有关其护理决策的权利的过程。通过评估所有可用的医疗保健选项，并根据现有的无偏见证据权衡患者的个人价值观和偏好，患者和医疗保健专业人员可以作为合作伙伴共同做出与健康相关的决定。我们试图评估感知SDM对患者报告的结果，医疗质量，和healthcare utilization.Methods的影响：从2010-2014年医疗支出小组调查（MEPS）队列中确定患者。对医疗保健提供者和系统的消费者评估（CAHPS）调查是为了在12点量表上创建对SDM满意度的加权综合得分，然后根据加权得分将SDM分类为最佳、平均或较差。采用加权和方差技术，以确保结果代表美国平民人口。卡方分析用于估计SDM分组之间的差异，并进行多变量逻辑回归以生成比值比（OR）和置信区间（CI）。三个类别的SDM满意度结果是倾斜的，46.6%（n = 29，807）的受访者报告最佳SDM，42.1%（n = 26，887）报告平均得分，只有11.3%（n = 7237）报告差感知SDM。非白人种族、较低的教育水平、低社会经济地位、未婚状态、无保险或保险不足状态均与较高的感知到的SDM发生率相关（p <0.05）。较差的SDM与较差的身体健康评分（OR：1.17; 95%CI 1.01-1.36）和较差的心理健康评分（OR：1.53; 95%CI 1.25-1.86）的几率增加相关。差的SDM与他汀类药物（OR：0.77; 95%CI 0.68-0.87）和阿司匹林（OR：0.86; 95%CI 0.77-0.95）的使用较少相关，这两种药物都是已确立的护理质量指标。差的SDM也与急诊科（艾德）利用率增加有关，与差的SDM相关的2次或2次以上艾德就诊的可能性增加（OR：1.25; 95%CI 1.06-1.49）。结论：差的SDM与患者报告的健康结果较差、既定质量指标较差和医疗保健利用率较高相关。虽然增加医生教育可能有助于优化SDM，但患者感知SDM的差异也受到患者固有特征的强烈驱动。(C)2018爱思唯尔公司All rights reserved.
Background: Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization.Methods: Patients were identified from the 2010-2014 Medical Expenditure Panel Survey (MEPS) cohort. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was levied to create a weighted composite score of satisfaction with SDM on a 12-point scale, and then categorized as optimal, average or poor SDM based on weighted scores. Weighting and variance techniques were applied to assure results were representative of the U.S. civilian population. Chi-square analysis was used to estimate differences across SDM groupings and multivariate logistic regression was performed to generate odds ratios (OR) and confidence intervals (CI).Results: The study cohort included 63,931 responses to the survey tool. Results of SDM satisfaction across the three categories were skewed, with 46.6% (n = 29,807) of the respondents reporting optimal SDM, 42.1% (n = 26,887) reporting average scores and only 11.3% (n = 7237) reporting poor perceived SDM. Non-white race, lower educational level, low socioeconomic status, non-married status, and uninsured or underinsured status were all associated with higher incidence of poor perceived SDM (p < .05). Poor SDM was associated with increased odds of poor physical health scores (OR: 1.17; 95% CI 1.01-1.36) and poor mental health scores (OR: 1.53; 95% CI 1.25-1.86). Poor SDM was associated with lower use of statins (OR: 0.77; 95% CI 0.68-0.87) and aspirin (OR: 0.86; 95% CI 0.77-0.95), both of which are established quality of care metrics. Poor SDM was also associated with increased emergency department (ED) utilization, with an increased likelihood of 2 or more ED visits associated with poor SDM (OR: 1.25; 95% CI 1.06-1.49).Conclusions: Poor SDM was associated with worse patient-reported health outcomes, worse established quality indicators, and higher healthcare utilization. While increasing physician education may help optimize SDM, differences in patient-perceived SDM were also strongly driven by inherent patient characteristics. (C) 2018 Elsevier Inc. All rights reserved.