Patient–Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States

Abstract

Background— Consumer-reported patient–provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative US adult population with established atherosclerotic cardiovascular disease. Methods and Results— The study population consisted of a nationally representative sample of 6810 individuals (aged ≥18 years), representing 18.3 million adults with established atherosclerotic cardiovascular disease (self-reported or International Classification of Diseases, Ninth Edition diagnosis) reporting a usual source of care in the 2010 to 2013 pooled Medical Expenditure Panel Survey cohort. Participants responded to questions from Consumer Assessment of Health Plans Survey that assessed PPC, and we developed a weighted PPC composite score using their responses, categorized as 1 (poor), 2 (average), and 3 (optimal). Outcomes of interest were (1) patient-reported outcomes: 12-item Short Form physical/mental health status, (2) quality of care measures: statin and ASA use, (3) healthcare resource utilization: emergency room visits and hospital stays, and (4) total annual and out-of-pocket healthcare expenditures. Atherosclerotic cardiovascular disease patients reporting poor versus optimal were over 2-fold more likely to report poor outcomes; 52% and 26% more likely to report that they are not on statin and aspirin, respectively, had a significantly greater utilization of health resources (odds ratio≥2 emergency room visit, 1.41 [95% confidence interval, 1.09–1.81]; odds ratio≥2 hospitalization, 1.36 [95% confidence interval, 1.04–1.79]), as well as an estimated $1243 ($127–$2359) higher annual healthcare expenditure. Conclusions— This study reveals a strong relationship between PPC and patient-reported outcomes, utilization of evidence-based therapies, healthcare resource utilization, and expenditures among those with established atherosclerotic cardiovascular disease.

Emergency Department Visits and Subsequent Hospital Admission Trends for Patients with Chest Pain and a History of Coronary Artery Disease

“…The increase in ED visits for CP may also be linked to a lack of programs for disease management education or support, as well as [22]. Although disease management through clinical care is provided through Medicaid and Medicare, these [23].…”

Association of Income Disparities with Patient-Reported Healthcare Experience

“…17,18 We summed the responses and developed a weighted average response from 1 to 3 with 1 indicating poor, 2 average, and 3 optimal patient-provider communication. 1 The responses to the PPC-related questions are also components of the ALERT model (Always, Listen Carefully, Explain Things Understandably, Respect What the Patient Has to Say, Time Management), designed to help physicians recall the CAHPS questions. 1 Shared Decision-making.…”

“…1 The responses to the PPC-related questions are also components of the ALERT model (Always, Listen Carefully, Explain Things Understandably, Respect What the Patient Has to Say, Time Management), designed to help physicians recall the CAHPS questions. 1 Shared Decision-making. Similar to the other domains of patient experience, we developed a weighted average response labeled 1 (poor), 2 (average) and 3 (optimal) from the participants' responses to the questions listed in Table e1.…”

“…Patient-centered care as evidenced by an improvement in patient report on healthcare experience has been identified by the Department of Health and Human Services (DHHS) as one of the strategies vital to the improvement of healthcare delivery and outcomes. 1 While there may have been substantial improvements in care and outcomes, major health disparities continue to exist, particularly for patients with limited economic resources. 2 Compared with high-income adults, those with limited financial resources have a fourfold higher rate of poor patient-reported health status.…”

Patients’ experiences of using the Integrated Palliative care Outcome Scale for a person‐centered care: A qualitative study in the specialized palliative home‐care context

“…For patients in palliative care, communication may be one of the most important components regarding quality of care (Heyland, ; Seccareccia et al, ). Reciprocal communication can empower patients to participate in decision‐making, maintain a sense of control, and positively influence perceptions of their physical and psychological well‐being (Okunrintemi et al, ; Stajduhar et al, ).…”