PATIENT-CENTERED CARE AND HEALTH CARE COSTS

背景资料。初步研究表明，以患者为中心的护理，其特点是纳入患者的疾病经历、心理社会背景和共同决策，可能会减少使用率，同时提高健康状况和满意度，特别是在出现不明原因的躯体症状的患者中。这些患者很常见，疾病负担和费用很高，而且经常对护理不满意。以患者为中心的态度是可变的，而且是可靠的。目前还没有发表的研究对这类患者中与医疗费用相关的相互作用因素进行评估。目标。研究医生以患者为中心的衡量标准与医疗成本(总成本、住院成本、门诊成本、检测成本和药物成本)、健康状况和满意度之间的关系；并确定有助于降低医疗成本的医患沟通特征。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，并对50名患者/医生进行研究。资料：2名SP访客模拟不明原因躯体症状患者的录音带、患者填写的问卷和SP。测量：SP访视：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；SPS和患者：健康护理环境问卷和参与式决策量表；费用来自管理型医疗数据库。分析：定性编码/编辑，以及对费用最高和最低四分位数的医生进行准统计分析。回归分析包括SP和调整后的患者以患者为中心的衡量标准和病例组合调整后的成本。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中的不足；(2)识别医生互动方式中可能导致使用率降低、成本降低和情绪困扰的可修改因素；(4)指导教育和质量改进计划的随机临床试验；(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.