Background Our healthcare system is moving towards patient-centered and value-based care models that prioritize health outcomes that matter to patients. However, little is known about what aspects of care patients would prioritize when presented with choices of desirable attributes and whether these patient priorities differ based on certain demographics. Objective To assess patients’ priorities for a range of attributes in ambulatory care consultations across five key health service delivery domains and determine potential associations between patient priorities and certain demographic profiles. Methods Using a What Matters to You survey patients ranked in order of importance various choices related to five health service domains (patient-physician relationship, personal responsibility, test/procedures, medications, and cost). Subjects were selected from two Johns Hopkins affiliated primary care clinics and a third gastroenterology subspecialty clinic over a period of 11 months. We calculated the percentage of respondents who selected each quality as their top 1–3 choice. Univariate and multivariate analyses determined demographic characteristics associated with patient priorities. Results Humanistic qualities of physicians, leading a healthy lifestyle, shared decision making (SDM) for medications and tests/procedures as well as knowledge about insurance coverage were the most frequently ranked choices. Privately insured and more educated patients were less likely to rank humanistic qualities highly. Those with younger age, higher educational attainment and private insurance had higher odds of ranking healthy lifestyle as a top choice. Those with more education had higher odds of ranking SDM as a top choice. Conclusions Identifying what matters most to patients is useful as we move towards patient-centered and Value Based Care Models. Our findings suggest that patients have priorities on qualities they value across key health service domains. Multiple factors including patient demographics can be predictors of these priorities. Elucidating these preferences is a challenging but a valuable step in the right direction.
Background Sitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients. Objective To examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting. Design In-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020. Participants Patients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital. Main Measures Patient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting. Key Results Of 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush ( p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%). Conclusions Patients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07231-4.
n spite of published reports highlighting the need to increase the number of physicians who identify with groups underrepresented in medicine (UiM), Black and Hispanic individuals each made up only 5% and 5.8%, respectively, of US physicians in 2019. 1,2 Due to these small numbers, UiM trainees often lack access to a community of coresidents, fellows, faculty, and mentors from similar racial or ethnic backgrounds. The deficiency of social support from individuals of similar backgrounds has been reported to hinder the personal and professional success of UiM trainees. 3-5 Decades Without Adequate Progress Since 1964, the Student National Medical Association (SNMA) has provided a diverse and welcoming community for medical students. Similarly, since 1895, the National Medical Association (NMA) has provided the same benefits to UiM faculty members. 6 These communities are designed to improve the recruitment, success, and retention of UiM physicians. However, there is a gap in a structured community specifically designed for UiM physicians enrolled in graduate medical education (GME). How does a health care system intentionally foster a community for diverse GME trainees and cultivate a support system for UiM trainees? There is a paucity of evidence outlining best practice strategies for building community among UiM GME trainees. We share a guide we used to fill this gap through the creation of a house staff diversity council (HSDC) at
4Background 5 Our healthcare system is moving towards patient-centered and value-based care models that 6 prioritize health outcomes that matter to patients. However, little is known about what aspects 7 of care patients would prioritize when presented with choices of desirable attributes and 8 whether these patient priorities differ based on certain demographics. 9 Objective 10 To assess patients' priorities for a range of attributes in ambulatory care consultations across 11 five key health service delivery domains and determine potential associations between patient 12 priorities and certain demographic profiles. 13 Methods 14 Using a What Matters to You survey patients ranked in order of importance various choices 15 related to five health service domains (patient-physician relationship, personal responsibility, 16 tests/procedures, medications and cost). Subjects were selected from two Johns Hopkins 17 affiliated primary care clinics and a third gastroenterology subspecialty clinic over a period of 11 18 months. We calculated the percentage of respondents who selected each quality as their top 1-19 3 choice. Univariate and multivariate analyses determined demographic characteristics 20 associated with patient priorities. 21 Results 22 Humanistic qualities of physicians, leading a healthy lifestyle, shared decision making (SDM) for 23 medications and tests/procedures and knowledge about insurance coverage were the most 24 frequently ranked choices. Privately insured and more educated patients were less likely to 25 rank humanistic qualities highly. Those with younger age, higher educational attainment and 26 private insurance had higher odds of ranking healthy lifestyle as a top choice. Those with more 27 education had higher odds of ranking SDM as a top choice. 28 Conclusions 29Identifying what matters most to patients is useful as we move towards patient-centered and 30 value based care models. Our findings suggest that patients have priorities on qualities they 31 value across key health service domains. Multiple factors including patient demographics can 32
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