Patient-Centered Care is Associated with Decreased Health Care Utilization
Patient-Centered Care is Associated with Decreased Health Care Utilization
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DOI：
10.3122/jabfm.2011.03.100170
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发表时间：
2011-05-01
影响因子：
2.9
通讯作者：
Azari, Rahman
中科院分区：
文献类型：
--
作者：
Bertakis, Klea D.;Azari, Rahman
目的：本文使用一个intermittent分析工具，以病人为中心的护理在初级保健设置的特点，并检查其与health care utilization.Methods的关系：五百九个新的成年患者随机照顾家庭医生和普通内科医生。适应戴维斯观察代码被用来衡量以病人为中心的实践风格。主要观察指标为1年内的医疗服务使用情况及相关费用。控制患者性别、年龄、教育、收入、自我报告的健康状况和健康风险行为（肥胖、酗酒和吸烟），在整个1- 10年中，以患者为中心的护理平均量较高，一年的研究期与专科护理的年就诊次数显著减少有关（P = 0.0209），住院率较低（P = 0.0033），实验室和诊断检查较少（P = 0.0027）。1年研究的总医疗费用也显著降低（P = 0.0002），专科护理诊所就诊的费用也显著降低（P = 0.0005），所有患者在同一时间段内以患者为中心的平均就诊量较大。与男性患者相比，女性患者的回归方程预测了15.47%的年医疗费用变化，其中31.18%的变化可以通过以患者为中心的护理的平均百分比来解释，控制了社会人口变量，健康状况和健康风险行为。以病人为中心的护理与医疗服务利用率下降和年度总费用降低有关。降低每年的医疗费用可能是以病人为中心的医疗访问的一个重要结果。（J Am Board Fam Med 2011; 24：229-239.）
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.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.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.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. (J Am Board Fam Med 2011; 24:229-239.)