PURPOSE Although patient-centered communication is associated with improved health and patient trust, information about the impact of patient-centered communication on health care costs is limited. We studied the relationship between patient-centered communication and diagnostic testing expenditures. METHODSWe undertook an observational cross-sectional study using covert standardized patient visits to study physician interaction style and its relationship to diagnostic testing costs. Participants were 100 primary care physicians in the Rochester, NY, area participating in a large managed care organization (MCO). Audio recordings of 2 standardized patient encounters for each physician were rated using the Measure of Patient-Centered Communication (MPCC). Standardized diagnostic testing and other expenditures, adjusted for patient demographics and case-mix, were derived from the MCO claims database. Analyses were adjusted for demographics and standardized patient detection. RESULTSCompared with other physicians, those who had MPCC scores in the lowest tercile had greater standardized diagnostic testing expenditures (11.0% higher, 95% confi dence interval [CI], 4.5%-17.8%) and greater total standardized expenditures (3.5% higher, 95% CI, 1.0%-6.1%). Whereas lower MPCC scores were associated with shorter visits, adjustment for visit length and standardized patient detection did not affect the relationship with expenditures. Total (testing, ambulatory and hospital care) expenditures were also greater for physicians who had lower MPCC scores, an effect primarily associated with the effect on testing expenditures.CONCLUSIONS Patient-centered communication is associated with fewer diagnostic testing expenditures but also with increased visit length. Because costs and visit length may affect physicians' and health systems' willingness to endorse and practice a patient-centered approach, these results should be confi rmed in future randomized trials. INTRODUCTIONP atient-centered communication is based on a moral philosophy that calls for physicians to expand upon the biomedical approach to care by (1) helping patients feel understood through inquiry into patients' needs, perspectives, and expectations; (2) attending to the psychosocial context; and (3) expanding patients' involvement in understanding their illnesses and in decisions that affect their health.1-3 Patient-centered communication is a complex construct, aspects of which have differential associations with such outcomes as patient satisfaction 4 and control of chronic disease. [5][6][7][8] Most physicians tend to use a biomedical rather than a patientcentered communication style, 9 whereas most patients prefer a patient-centered approach. 10,11 Although patient-centered communication should not be advocated on the basis of cost considerations alone, it is important to understand the cost implications of such an approach from a health policy perspec- 12,13 Even though both studies reported that elements of patient-centered communication are associated ...

This article reviews the evidence for the effectiveness of family interventions in the prevention and treatment of physical disorders. Pathways by which families influence physical health and a typology of family interventions are described. Family intervention studies, particularly randomized clinical trials, are reviewed in four clinical areas: family caregiving of elders, childhood chronic illness, spouse involvement in chronic adult illnesses, and health promotion/disease prevention. Implications for family clinicians and recommendations for future research are presented.

Researchers in the Program for Biopsychosocial Studies at the University of Rochester have applied quantitative and qualitative research paradigms to explore the healthcare outcomes associated with relationship-centered patient care. Studies converge to show that when primary care physicians are more relationship-centered (versus physician-centered) patients are likely to display higher satisfaction, better adherence to prescriptions, more maintained behavior change, better physical and psychological health, and to initiate less malpractice litigation. Further, when patients' families have more positive interactions, patients have better physical

This paper reports on the development, reliability, and validity of a self‐report scale to assess from the recipients' perspective two factors derived from Expressed Emotion (EE) theroy. The Family Emotional Involvement and criticism Scale (FEICS) has two subsles: Perceived Criticism (PC) and intensity of Emotional Involvement (EI). These two factors are analogous to Critical Comments and Emotional Overeinovlvement, the two main factors of EE that are assessed through the camberwell Family Interview, the original direct observation measure of EE. FEICS was completed by 83 respondents who were a random sample of patients over 40 years of age receiving care at a Fmily Medicince Center. Cronbach's alpha was. 82 for the PC subscale and .74 for the EI subscale. Confirmatory factor analysis showed that each item loaded onn its propsed factor (all at ≥ .50) and not with the other factor (all at ≤ .15). The subscales exhibited expected correlations and partial correlations with FACES III subscales, ISEL subscales, the SCL‐90 depression and anxiety subscale, and demographic variables. We conclude that the EFICS is a reliable instrument with perliminary evidence of its construct and criterion validity.