Patient-Centered Communication and Diagnostic Testing

Abstract

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 ...

Influence of Elective versus Emergent Hospital Admission on Patient Satisfaction

“…36,38,39 In particular, patient-centered communication may enhance the doctor-patient relationship while encouraging efficient, effective care. [3][4][5][6][7][8] However, it remains unclear whether widely used measures of patient satisfaction capture nuanced dimensions of patient-centeredness, 9 such as the physician-patient partnership 8 or physicians' responsiveness to patients' contextual factors or emotions. 40,41 Our findings nevertheless suggest that some types of health care utilization, in this case elective hospitalization, may increase satisfaction.…”

“…[3][4][5][6][7][8][9] At the same time, patient satisfaction has been consistently associated with the fulfillment of patient requests, 10,11 and clinicians have expressed concern that incentives to maximize satisfaction may lead to excessive testing or treatment in attempts to satisfy patients. [12][13][14] Research also suggests that higher satisfaction may be associated with more care and higher mortality, 15,16 raising the possibility that the greater intensity of care may be for discretionary, possibly harmful tests or treatments.…”

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“…If physicians reported suspicion and could report any details regarding the SP, the visit was considered detected. Although prior analyses did not reveal differences between detected and undetected visits, 17 we did not want to risk that unmeasured differences might exist, and thus excluded detected visits. Reasons for detection included closed physician practice and physician notification by staff.…”

Caregiver perceptions about the impact of caring for patients with wet age-related macular degeneration

“…This leads to better understanding of their health concern and in turn more accurate diagnosis and treatment. [14][15][16] It is likely that this also applies to situations of informal or family caregiving, but to our knowledge, no studies have investigated the impact of caring as it relates to personality attributes such as compassion and empathy. The aim of this study was to explore the perceptions of caregivers in relation to the most important aspects of caring, as described by their extended responses to two questions:…”