Determinants and outcomes of patient-centered care.

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.