PATIENT-CENTERED CARE AND HEALTH CARE COSTS

背景 初步研究表明，以病人为中心的护理，其特点是将病人的疾病经验，社会心理背景和共同决策，可能会减少利用，同时改善健康状况和满意度，特别是在病人谁目前与不明原因的躯体症状。这类患者较为常见，疾病负担和费用较高，且往往对护理不满意。以患者为中心是可变的，并且可以可靠地测量。没有发表的研究评估了与这一患者人群的医疗保健费用相关的干扰因素。目标。研究医生以病人为中心的措施和医疗保健费用（总，住院，门诊，测试和药物），健康状况和满意度之间的关系;并表征有助于降低医疗保健费用的患者-医生沟通的特点。方法：对100名初级保健医生进行多方法研究，按病例组合调整后的总医疗费用分层，50名患者/医生。资料：模拟不明原因躯体症状患者的2次SP访视录音，患者和SP完成的问卷调查。措施：SP访问：以患者为中心的沟通评分方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; SP和患者：医疗保健氛围问卷和决策量表;管理式医疗数据库的费用。分析：定性编码/编辑，和准统计分析的医生在最高和最低成本的四分位数。回归分析包括SP和调整后的患者以患者为中心的措施和病例组合调整后的成本。重要性：我们将（1）解决以患者为中心的医生行为与医疗保健成本之间关系的研究不足（2）认识到医生互动方式中的可修改因素，这些因素可能导致利用率降低，成本降低，和识别情绪困扰（4）指导教育和质量改善计划的随机临床试验和（5）开发一种新的研究方法，在成本数据与临床就诊的行为和感知指标之间提供重要联系。

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.