How Exam Rooms Enhance Physicians' Patient-Centeredness

描述（由申请人提供）：以患者为中心的沟通仍然被认为是老年患者和医生之间治疗关系的核心组成部分。这种交流的大部分是在检查室的物理环境中发起、发展和维持的。然而，这一物理环境在塑造沟通方面的作用尚未得到系统的研究。一项关于医生与老年患者互动的小型初步研究（N=8）表明，医生在检查室中更以患者为中心，其物理属性具有促进互动的自由度。拟议的研究旨在扩大这一初步工作。这项建议的具体目标是： 1.预先测试和修订措施的物理设置属性和病人为中心的初步研究。研究人员将独立审查20%的磁带，然后合作达成共识的测量工具。 2.在50次二元接触中分别编码和编译物理设置属性和以患者为中心;本研究阶段将使用对研究概念基础和彼此任务不知情的编码员。 3.分析数据，并描绘条件下，检查室的物理属性成为与医生的病人为中心，使用定性方法技术。 这项拟议的研究50录像带的医生和老年患者之间的二元遭遇，在他们的自然发生的设置，是一个更大的数据集的489 NIA存档录像带的二次数据分析。 该数据子集将代表原始样本的中西部和西南地区。他们还将代表三种类型的设置，特别是独立实践，管理式护理和学术环境。此外，我们建议包括医生和老年患者的性别和种族特征的混合。选择这样一个有目的的样本的基本目标是，它包括各种临床情况，以检查我们的主要问题：检查室的物理设置是医生与老年患者沟通的一个突出因素吗？

DESCRIPTION (PROVIDED BY APPLICANT): Patient-centered communication continues to be acknowledged as a central component for a therapeutic relationship between older patients and physicians. Much of this communication is initiated, developed and sustained within the physical setting of the exam room. Yet the role of that physical setting in shaping communication has not been systematically examined. A small, preliminary study (N=8) of physician-older patient interactions indicate that physicians were more patient-centered in exam rooms with physical attributes that had the latitude to facilitate interaction. The proposed research seeks to expand this preliminary work. The specific aims of this proposal are to: 1. Pretest and revise measures of physical setting attributes and patient-centeredness developed in the preliminary study. The investigators will review 20% of the tapes independently and then collaboratively to arrive at consensus on measurement instruments. 2. Code and compile physical setting attributes and patient-centeredness separately in fifty dyadic encounters; coders blinded to the conceptual basis of the study and to each other's tasks will be used for this phase of study. 3. Analyze the data and delineate the conditions under which physical attributes of the exam room become linked with physician's patient-centeredness using qualitative method techniques. This proposed study of fifty videotapes of dyadic encounters between physicians and older patients, in their naturally occurring settings, is a secondary data analysis of a larger dataset of 489 NIA archived videotapes. This subset of data will represent both the Midwest and Southwest regions of the original sample. They will also represent three types of settings specifically, independent practice, managed care and academic settings. Further, we propose to include a mix of gender and race characteristics for both physicians and older patients. The underlying goal in selecting such a purposive sample is that it comprises a variety of clinical situations to examine our main question: Is the physical setting of the exam room a salient factor in physicians' communication with their older patients?