Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA 95817, USA.
J Am Board Fam Med. 2011 May-Jun;24(3):229-39. doi: 10.3122/jabfm.2011.03.100170.
This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization.
Five hundred nine 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 their use of medical services and related charges monitored over 1 year.
Controlling for patient sex, age, education, income, self-reported health status, and health risk behaviors (obesity, alcohol abuse, and smoking), a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care (P = .0209), less frequent hospitalizations (P = .0033), and fewer laboratory and diagnostic tests (P = .0027). Total medical charges for the 1-year study were also significantly reduced (P = .0002), as were charges for specialty care clinic visits (P = .0005), for all patients who had a greater average amount of patient-centered visits during that same time period. For female patients, the regression equation predicted 15.47% of the variation in total annual medical charges compared with male patients, for whom 31.18% of the variation was explained by the average percent of patient-centered care, controlling for sociodemographic variables, health status, and health risk behaviors.
Patient-centered care was associated with decreased utilization of health care services and lower total annual charges. Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered.
本文使用互动分析工具来描述初级保健环境中的以患者为中心的护理，并研究其与医疗保健利用之间的关系。
将 509 名新成年患者随机分配给家庭医生和普通内科医生进行治疗。使用 Davis 观察代码的改编版来衡量以患者为中心的实践方式。主要观察指标为他们在 1 年内监测的医疗服务和相关费用的使用情况。
在控制患者性别、年龄、教育程度、收入、自我报告的健康状况和健康风险行为（肥胖、酗酒和吸烟）后，在整个 1 年研究期间记录的以患者为中心的护理平均量较高与专业护理就诊次数的年减少量显著相关（P =.0209），住院次数减少（P =.0033），以及实验室和诊断测试次数减少（P =.0027）。1 年研究期间的总医疗费用也显著降低（P =.0002），以及专门护理诊所就诊的费用（P =.0005），对于在此期间有更多以患者为中心的就诊的所有患者而言。对于女性患者，与男性患者相比，回归方程预测了总年度医疗费用的 15.47%的变化，而对于男性患者，平均以患者为中心的护理比例解释了 31.18%的变化，同时控制了社会人口统计学变量、健康状况和健康风险行为。
以患者为中心的护理与医疗服务利用率的降低和总年度费用的降低有关。减少年度医疗费用可能是以患者为中心的就诊的一个重要结果。
