Determinants and outcomes of patient-centered care.

Abstract

OBJECTIVE: This paper defines an interactional analysis instrument to characterize patient-centered care and identify associated variables. METHODS: In this study, 509 new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were visit-specific satisfaction and healthcare resource utilization. RESULTS: In initial primary care visits, patient-centered practice style was positively associated with higher patient self-reported physical health status (p=0.0328), higher educational level (p=0.0050), and non-smoking status (p=0.0108); it was also observed more often in the interactions of family physicians compared to internists (p=0.0003). Controlling for patient sociodemographic variables, self-reported health status, pain, health risk behaviors (obesity, alcohol abuse, and smoking), and clinic assignment, patient satisfaction was not related to the provision of patient-centered care. Moreover, a higher average amount of patient-centered care recorded in visits throughout the one-year study period was significantly related to lower annual medical charges (p=0.0003). CONCLUSIONS: Patient-centered care was observed more often with family physician caring for healthier, more educated patients, and was associated with lower charges. PRACTICE IMPLICATIONS: Reduced annual medical care charges are an important outcome of patient-centered medical visits.