PATIENT-CENTERED CARE AND HEALTH CARE COSTS

背景。初步研究表明，以患者为中心的护理，其特点是将患者的疾病经历、社会心理环境和共同决策纳入其中，可能会降低利用率，同时改善健康状况和满意度，特别是对于出现无法解释的躯体症状的患者。这些患者很常见，疾病负担和费用高，往往对护理不满意。以病人为中心是可变的，也是可靠的可测量的。没有发表的研究评估了与这类患者的医疗保健费用相关的相互影响因素。目标。检验医生以病人为中心的各项指标与医疗保健费用（总费用、住院费用、门诊费用、检查费用和用药费用）、健康状况和满意度的关系；并描述有助于降低医疗成本的医患沟通的特征。方法：对100名初级保健医生进行多方法研究，按病例混合调整后的医疗保健总费用分层，50名患者/医生。资料：模拟躯体症状不明患者的2次SP就诊录音、患者和SP填写的问卷。测量方法：SP访视：以患者为中心的沟通评分法和非语言沟通的薄片分析；患者：SF-12，患者满意度问卷；健康状况变化问题；卫生服务提供者与患者：卫生保健氛围问卷与参与式决策量表来自管理式医疗数据库的成本。分析：定性编码/编辑，以及最高和最低成本四分位数的医生的准统计分析。回归分析包括SP和调整的患者以患者为中心的措施和病例组合调整的成本。意义:我们将(1)解决以患者为中心的医生行为如何与医疗成本相关的研究缺陷(2)认识到医生互动方式中可改变的因素，这些因素可能导致利用率下降，成本下降，对情绪困扰的识别(4)指导教育和质量改进项目的随机临床试验，(5)开发一种新的研究方法，在成本数据与临床遭遇的行为和感知测量之间提供重要联系。

Background. Preliminary studies indicate that patient-centered care, characterized by incorporating the patient's experience of illness, the psychosocial context and shared decision-making, may reduce utilization while improving health status and satisfaction, especially among patients who present with unexplained somatic symptoms. These patients are common, incur high illness burden and cost, and are often dissatisfied with care. Patient-centeredness is mutable and reliably measurable. No published studies have assessed interactional factors associated with health care costs in this population of patients. Aims. To examine the relationship between measures of physicians' patient-centeredness and health care costs (total, inpatient, outpatient, testing and medication), health status and satisfaction; and to characterize features of patient-physician communication that contribute to lower health care costs. Methods: Multi-method study of 100 primary care physicians stratified by case-mix-adjusted total health care costs, and 50 patients/physician. Data: audiotapes of 2 SP visits simulating patients with unexplained somatic symptoms, questionnaires completed by patients and SPs. Measures: SP visits: Patient-Centered Communication Scoring Method and Thin Slice Analysis of non-verbal communication; Patients: SF-12, Patient Satisfaction Questionnaire; Health Status Change Question; SPs and patients: Health Care Climate Questionnaire and the Participatory DecisionMaking Scale; costs from a managed care database. Analyses: Qualitative coding/editing, and quasi-statistical analysis of physicians in highest and lowest cost quartiles. Regression analyses including SP and adjusted patient measures of patient-centeredness and case-mix adjusted costs. Significance: We will (1) address a deficiency in research on how patient-centered physician behaviors relate to health care costs (2 ) recognize modifiable factors in physician interaction style that can lead to decreased utilization, decreased costs, and recognition of emotional distress (4) guide randomized clinical trials of educational and quality improvement programs and (5) develop a new research methodology that provides an important link between cost data and behavioral and perceived measures of clinical encounter.